What is the best surgical approach for redo pyeloplasty in children? A systematic review and meta-analysis

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Surgical Outcomes

Background:

• Redo pyeloplasty is a complex procedure for recurrent pelvi-ureteric junction obstruction (PUJO) in children.
• Optimal surgical approach for redo pyeloplasty lacks consensus, impacting renal function and development.
• Comparison of open, laparoscopic, and robot-assisted laparoscopic (RAL) techniques is crucial for safety and efficacy.

Purpose of the Study:

• To compare the safety and efficacy of open, laparoscopic, and RAL approaches for redo pyeloplasty in children with recurrent PUJO.
• Evaluate surgical outcomes, complication rates, and success rates across different techniques.
• Identify the most suitable surgical strategy for managing recurrent PUJO.

Main Methods:

• Systematic literature search of PubMed and Scopus databases.
• Inclusion of studies comparing surgical approaches for pediatric redo pyeloplasty; exclusion of endoscopic treatments and primary procedures.
• Meta-analysis and forest plots to synthesize quantitative data; risk of bias assessment using Newcastle-Ottawa score.

Main Results:

• Four studies met inclusion criteria, comparing laparoscopy (68 cases) with open surgery (78 cases); no RAL studies were included.
• Laparoscopic and open approaches demonstrated similar complication and success rates (p=0.74 and p=0.99).
• Laparoscopic surgery duration was significantly longer than open surgery (p<0.0001) with considerable heterogeneity.

Conclusions:

• Laparoscopy may offer comparable safety and success to open surgery for pediatric redo pyeloplasty, but evidence is limited.
• Current evidence is insufficient to definitively recommend one approach over the other.
• There is a significant lack of research comparing robot-assisted laparoscopic surgery with other methods for redo pyeloplasty.