Five years’ experience of laparoscopic-assisted dismembered pyeloplasty versus open dismembered pyeloplasty

Abstract

Purpose Pyeloplasty for ureteropelvic junction obstruction (UPJO) in children has traditionally been performed using an open technique. However, the large lumbar incision in open pyeloplasty necessitates several weeks before a return to normal activity and requires significant tissue retraction to expose the field; hence, the damage is often more than that anticipated. We present our long-term experience with laparoscopic-assisted pyeloplasty in the treatment of UPJO, to evaluate the feasibility, safety, and long-term outcome of this technique in children.
Patients and methods In total, 40 children with UPJO requiring operative repair were included in the study. Twenty patients with UPJO were randomly selected to undergo open dismembered pyeloplasty (group A) and the remaining 20 patients to undergo laparoscopic-assisted dismembered pyeloplasty (group B) at the Pediatric
Surgery Department between January 2013 and December 2017. All patients were followed-up for 5 years postoperatively. The outcome was measured by the ultrasonography and diuretic renography with resolution of obstructive symptoms.
Results The mean laparoscopic procedure time was 25 min. There was a slight relationship between age and operative time. No major perioperative complications
occurred in any cases. Renal pelvic anterior–posterior diameter at postoperative ultrasonography significantly decreased (P<0.05). Postoperative split renal function on diuretic renography significantly improved. Overall, successful resolution of UPJO was observed in all patients.
Conclusion Laparoscopic-assisted pyeloplasty appears to be a safe, feasible, and effective alternative to open pyeloplasty in children. There are shorter operative times in the laparoscopic-assisted pyeloplasty and shorter overall hospitalization. It avoids large lumbar incision and gives excellent functional and cosmetic results. 

Keywords: laparoscopy-assisted pyeloplasty, minimally invasive surgery, ureteropelvic junction obstruction