Laparoscopically assisted pyeloplasty for ureteropelvic junction obstruction: a transperitoneal versus a retroperitoneal approach

Abstract

Objectives To compare the results of a transperitoneal laparoscopic-assisted dismembered pyeloplasty (TLADP) with an extraperitoneal laparoscopic-assisted dismembered pyeloplasty in the management of children with ureteropelvic junction (UPJ) obstruction.
Methods Eighteen children (mean 29 months, range 3 months to 10 years) underwent TLADP. An additional 11 children (mean 3.6 years, range 3 months to 11 years) underwent similar procedures through a retroperitoneal approach (RLADP). We retrospectively compared the operative time, hospital stay, postoperative complications, and follow-up in both the groups.
Results The mean operative time was significantly shorter in the TLADP group (100.6 vs. 119.2 min, P< 0.05). The duration of postoperative hospital stay was better in the RLADP group than that in the TLADP group (5.3 vs. 4.2 days) but was not statistically significant. No intraoperative complications occurred in either group, but postoperative urinoma was found in one patient of the TLADP group and persistent postoperative pain was found in one patient of the RLADP group. The mean follow-up was 5.6 years in TLADP (range 4–9 years) and 26 months in RLADP (range 6 months to 4 years). A significant improvement in renal function was achieved in both the groups. We had to shift to an open technique for two patients of the TLADP group; both were obese children, 4 and 10 years of age.
Conclusion Both TLADP and RLADP have been used successfully in the management of UPJ obstruction in children. We believe that RLADP is more suitable in older and obese children.

Keywords: laparoscopy, pyeloplasty, ureteropelvic junction obstruction