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Comparative, Prospective, Case-Control Study of Open versus Laparoscopic Pyeloplasty in Children with Ureteropelvic
Lisandro A Piaggio1, Juan P Corbetta2, Santiago Weller2
1Division of Pediatric Urology, Hospital IGA Dr. José Penna, Hospital Italiano Regional del Sur, Hospital Privado Dr. Raúl Matera , Bahía Blanca , Argentina.
Insights
Laparoscopic pyeloplasty (LP) in children offers shorter hospital stays and reduced narcotic needs compared to open pyeloplasty (OP), with similar long-term success rates for ureteropelvic junction obstruction.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
Background:
- Ureteropelvic junction obstruction (UPJO) is a common cause of pediatric kidney obstruction.
- Pyeloplasty is the gold standard surgical treatment for UPJO.
- Comparing open pyeloplasty (OP) with laparoscopic pyeloplasty (LP) is crucial for optimizing pediatric surgical care.
Purpose of the Study:
- To compare the clinical outcomes of open pyeloplasty (OP) versus laparoscopic pyeloplasty (LP) in pediatric patients.
- To evaluate patient recovery metrics including analgesia requirements and length of hospitalization.
- To assess the long-term efficacy of both surgical techniques in resolving UPJO.
Main Methods:
- A multicenter, prospective, case-control study was conducted.
- Patients with UPJO were offered either LP or OP.
- Data collected included surgical time, complications, pain scores, and length of hospitalization.
Main Results:
- Laparoscopic pyeloplasty (LP) procedures were longer than open pyeloplasty (OP) (188 vs. 65 minutes).
- LP resulted in shorter hospitalizations (1.9 vs. 2.5 days) and significantly lower postoperative narcotic requirements (0.06 vs. 1.7 mg/kg morphine).
- Both techniques demonstrated similar efficacy and complication rates, with no failures at a mean follow-up of 58 months.
Conclusions:
- Laparoscopic pyeloplasty (LP) is a safe and effective alternative to open pyeloplasty (OP) in children.
- LP offers advantages in terms of reduced pain and shorter hospital stays.
- Both OP and LP provide comparable long-term resolution rates for UPJO.
Introduction:
We compare open pyeloplasty (OP) versus laparoscopic pyeloplasty (LP) in children in a multicenter, prospective, case-control study.
Materials And Methods:
From May 2007 to March 2009, a program was established at Hospital Garrahan, the reference center, to perform LP with a mentoring surgeon that would attend the institution once a month. Every new case of ureteropelvic junction obstruction (UPJO) diagnosed in the reference institution was offered to participate in the study. If the patient was enrolled, it was scheduled for LP. The following patient diagnosed with UPJO was operated on with open technique and served as a case-control. In three other facilities, patients were only offered LP and had a matched control open case at the reference institution. The first end point of the study was patient recovery: analgesia requirement and length of hospitalization (LOH). The second end point of the study was resolution of UPJO in long-term follow-up for the two techniques. Demographic data, surgical time, perioperative complications, analgesia requirement, analgesia score during hospitalization, LOH, and outcome were recorded. Both groups received the same postoperative indications for pain control. Parents were asked to assess pain in their children every 4 h postoperatively and to complete a pain scale chart to which the nurses were blinded.
Results:
Fifteen OP and 15 LP were compared. Groups were similar with regard to sex, age, weight, and laterality. Mean surgical time was longer in LP than in OP group (mean 188 versus 65 min) (p < 0.01). Hospitalization was shorter for LP group with a mean of 1.9 versus 2.5 days for OP group (p < 0.05). Postoperative analgesia requirement was significantly higher in the OP group with a mean use of morphine of 1.7 versus 0.06 mg/kg in the LP group (p < 0.05). Pain scores were similar in both the groups. At a mean follow-up of 58 months there were no failures.
Conclusion:
In this prospective comparative cohort, LP was a longer procedure than OP. Both procedures had the same efficacy and complication rates, but patients undergoing LP needed fewer narcotics for pain control and had a shorter hospitalization.
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