Long-term, single-center study comparing open and laparoscopic procedures for congenital midureteral obstruction in
Guanglun Zhou1, Man Jiang2, Jianchun Yin1
1Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, 518000, Guangdong, People's Republic of China.
Insights
Laparoscopic ureteroureterostomy is a safe and effective treatment for congenital midureteral obstruction in children. This minimally invasive approach offers shorter operative times and hospital stays compared to open surgery.
Area of Science:
- Pediatric surgery
- Urology
- Minimally invasive surgery
Background:
- Congenital midureteral obstruction (CMO) can lead to significant renal complications in children.
- Surgical management is often required to restore proper urinary flow.
- Both open and laparoscopic techniques have been utilized for ureteroureterostomy.
Purpose of the Study:
- To compare the safety and outcomes of open ureteroureterostomy (OU) versus laparoscopic ureteroureterostomy (LU) in pediatric patients with CMO.
- To evaluate operative time, hospital stay, costs, complications, and success rates between the two surgical approaches.
Main Methods:
- Retrospective analysis of 18 patients undergoing OU and 26 patients undergoing LU between 2008 and 2022.
- Data collected included operative time, postoperative hospital stay, hospital costs, and complication rates.
- Success rates and complication severity (Clavien-Dindo classification) were assessed.
Main Results:
- Laparoscopic ureteroureterostomy (LU) demonstrated significantly shorter operative times (85.8 ± 16.5 min) and postoperative hospital stays (8.3 ± 1.7 days) compared to open ureteroureterostomy (OU) (106.3 ± 21.4 min, 11.6 ± 1.9 days).
- All patients achieved successful surgical outcomes with a median follow-up of 42 months.
- While complications occurred in both groups (2 in OU, 1 in LU), there was no statistically significant difference in complication rates or severity (Clavien-Dindo grade II).
Conclusions:
- Laparoscopic ureteroureterostomy is a safe and effective treatment for congenital midureteral obstruction in children.
- The laparoscopic approach offers advantages including reduced operative time and shorter hospital stays.
- Laparoscopic procedures are recommended as the primary surgical option for pediatric CMO management.
Purpose:
To compare the safety and outcomes of open and laparoscopic procedures in the management of congenital midureteral obstruction in children (CMO).
Methods:
Between February 2008 and February 2022, a total of 18 patients underwent open ureteroureterostomy (OU group), and 26 underwent laparoscopic ureteroureterostomy (LU group). The operative time, postoperative hospital stay, hospital costs, postoperative complications, and success rates of the two groups were compared.
Results:
The median age of the patients was 59 months, with 29 patients presenting with asymptomatic hydronephrosis, 12 with intermittent abdominal pain, and 3 with flank mass. The median follow-up time was 42 months, and all patients were successfully treated surgically. The operative time and postoperative hospital stay in the LU group were shorter than those in the OU group (106.3 ± 21.4 vs. 85.8 ± 16.5 min, 11.6 ± 1.9 vs. 8.3 ± 1.7 days, respectively; p < 0.05). The OU group had two postoperative complications, both of which were classified as Clavien-Dindo grade II based on the Clavien-Dindo classification. One case of postoperative complication occurred in the LU group, which was classified as Clavien-Dindo Grade II. There was no significant statistical difference in complications between the two groups (P > 0.05).
Conclusions:
Our data showed that laparoscopic ureteroureterostomy is a safe and effective treatment for congenital midureteral obstruction in children, and provides several advantages, including fewer postoperative complications, shorter postoperative hospital stay, and a shorter operative time. Laparoscopic procedures should be the first choice for treating children with congenital midureteral obstructions.
