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Latitudes and attitudes: A multinational study of laparoscopic pyeloplasty in children
Pilar Echeverria1, Francisco Reed L2, John M Gatti3
1Hospital Exequiel González Cortés, Santiago, Chile.
Insights
Laparoscopic pyeloplasty is a safe and effective treatment for ureteropelvic junction obstruction in children, showing consistent success across diverse global institutions. This minimally invasive approach offers favorable outcomes with low complication rates.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
Background:
- Ureteropelvic junction (UPJ) obstruction is a common congenital anomaly in children.
- The Anderson-Hynes technique is the gold standard for UPJ obstruction repair.
- Laparoscopic pyeloplasty offers potential benefits over open surgery, including reduced pain and shorter hospital stays.
Purpose of the Study:
- To evaluate the outcomes and complications of laparoscopic pyeloplasty for primary UPJ obstruction.
- To assess the safety and efficacy of this technique across diverse international pediatric urology centers.
Main Methods:
- A retrospective, descriptive study involving 11 tertiary pediatric urology institutions worldwide.
- Analysis of data from 744 laparoscopic pyeloplasties performed over a 9-year period.
- Inclusion of demographic data, perioperative management, outcomes, and complication rates.
Main Results:
- 744 laparoscopic pyeloplasties were performed in 743 children with a mean follow-up of 31 months.
- Success rate was high, with 4% requiring re-operation and 0.6% requiring nephrectomy.
- Complications occurred in 7.5% of cases, with 1% being severe (Clavien-Dindo IIIb).
Conclusions:
- Laparoscopic pyeloplasty is a safe and successful treatment for pediatric UPJ obstruction.
- Outcomes are consistent across diverse geographic and economic settings.
- Minimally invasive pyeloplasty is a viable alternative to open surgery globally.
Purpose:
The Anderson-Hynes technique has been the treatment of choice for primary ureteropelvic junction obstruction in children. Laparoscopic approach has shown similar outcomes to open, with advantages of shorter hospital stay and less pain. We reviewed the experience of 11 geographically diverse, tertiary pediatric urology institutions focusing on the outcomes and complications of laparoscopic pyeloplasty.
Materials And Methods:
A descriptive, retrospective study was conducted evaluating patients undergoing Anderson-Hynes dismembered laparoscopic pyeloplasty. Centers from four different continents participated. Demographic data, perioperative management, results, and complications are described.
Results:
Over a 9-year period, 744 laparoscopic pyeloplasties were performed in 743 patients. Mean follow-up was 31 months (6-120m). Mean age at surgery was 82 months (1 w-19 y). Median operative time was 177 min. An internal stent was placed in 648 patients (87%). A catheter was placed for bladder drainage in 702 patients (94%). Conversion to open pyeloplasty was necessary in seven patients. Average length of hospital stay was 2.8 days. Mean time of analgesic requirement was 3.2 days. Complications, according to Clavien-Dindo classification, were observed in 56 patients (7.5%); 10 (1%) were Clavien-Dindo IIIb. Treatment failure occurred in 35 cases with 30 requiring redo pyeloplasty (4%) and 5 cases requiring nephrectomy (0.6%).
Conclusion:
We have described the laparoscopic pyeloplasty experience of institutions with diverse cultural and economic backgrounds. They had very similar outcomes, in agreement with previously published data. Based on these findings, we conclude that laparoscopic pyeloplasty is safe and successful in diverse geographics areas of the world.
