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An updated meta-analysis of laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children
Yidong Huang1, Yang Wu1, Wei Shan1
1Department of Pediatric Surgery, West China Hospital of Sichuan University Chengdu 610041, Sichuan, P. R. China.
Insights
Laparoscopic pyeloplasty (LP) is a feasible and safe option for treating ureteropelvic junction obstruction in children, offering shorter hospital stays and fewer complications than open pyeloplasty (OP). Further research is needed to confirm these findings.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of congenital hydronephrosis in children.
- Traditional open pyeloplasty (OP) has been the gold standard, but minimally invasive techniques are increasingly explored.
Purpose of the Study:
- To compare the feasibility and safety of laparoscopic pyeloplasty (LP) versus open pyeloplasty (OP) in pediatric patients with UPJ obstruction.
Main Methods:
- A meta-analysis of 15 comparative studies and one randomized controlled trial (RCT) was conducted.
- Data sources included PubMed, Web of Science, and Cochrane Library up to October 2014.
- Perioperative outcomes such as length of stay, operative time, complications, and success rates were analyzed.
Main Results:
- Laparoscopic pyeloplasty (LP) was associated with a shorter length of hospital stay (WMD: -1.92 days) and potentially reduced complications (OR: 0.71) compared to open pyeloplasty (OP).
- Operative time was longer for LP (WMD: 48.64 minutes), but success rates were comparable (RD: 0.01).
Conclusions:
- Laparoscopic pyeloplasty (LP) demonstrates feasibility and safety for treating pediatric UPJ obstruction, particularly in high-volume centers with experienced surgeons.
- Further randomized controlled trials are recommended to address potential biases and confirm the long-term efficiencies of LP.
Purpose:
To further explore the feasibility and safety of laparoscopic pyeloplasty (LP) in children with ureteropelvic junction obstruction compared with open pyeloplasty (OP).
Methods:
PUBMED, Web of science and Cochrane library were searched until Oct. 2014 to find eligible studies. WMD, OR, RD and their 95% CIs were used to estimate the difference. Baseline such as age, gender and crossing vessel, perioperative outcomes such as length of stay, operative time, overall complications, and success rate were compared. All the meta-analyses were performed in Revman 5.2.
Results:
15 comparative studies and one RCT were eligible and included in the meta-analysis. Compared with OP, LP groups might be associated with shorted length of hospital stay (WMD: -1.92, 95% CI: -2.45--1.39), reduced complications (OR: 0.71, 95% CI: 0.49-1.01) and equal success rate (RD: 0.01, 95% CI: -0.02-0.04), but prolonged operative time (WMD: 48.64, 95% CI: 31.16-66.12).
Conclusion:
Our findings supported that laparoscopic pyeloplasty is feasibility and safety in the treatment of UPJ obstruction in children, especially in high-volume centers with experienced experts. Considering the select bias and recall bias, more RCTs are required to further explore the efficiencies of LP.
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