Laparoscopic vs Open Pyeloplasty in Children: Results of a Randomized, Prospective, Controlled Trial

Abstract

No AccessJournal of UrologyPediatric Urology1 Mar 2017Laparoscopic vs Open Pyeloplasty in Children: Results of a Randomized, Prospective, Controlled Trial John M. Gatti, Sable P. Amstutz, Paul R. Bowlin, Heidi A. Stephany, and J. Patrick Murphy John M. GattiJohn M. Gatti Children's Mercy Hospital, Kansas City, Missouri , Sable P. AmstutzSable P. Amstutz University of Kansas Medical Center, Kansas City, Kansas , Paul R. BowlinPaul R. Bowlin Children's Mercy Hospital, Kansas City, Missouri , Heidi A. StephanyHeidi A. Stephany Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania , and J. Patrick MurphyJ. Patrick Murphy Children's Mercy Hospital, Kansas City, Missouri View All Author Informationhttps://doi.org/10.1016/j.juro.2016.10.056AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Open dismembered pyeloplasty is the preferred repair for ureteropelvic junction obstruction. Minimally invasive techniques have been applied to the original open approach but no clear advantage has been demonstrated for these technological advances. We evaluate outcomes between transperitoneal laparoscopic and open pyeloplasty in children. Materials and Methods: All children 1 to 18 years old with ureteropelvic junction obstruction requiring operative repair were offered enrollment in the study. Patients were prospectively randomized to either laparoscopic or open pyeloplasty through a flank incision. Results: A total of 50 patients in the laparoscopic group and 48 in the open group were enrolled from 2005 to 2014. Mean followup was similar between the groups (13.7 months in the laparoscopic group vs 12.3 months in the open group, p = 0.54). The only significantly different outcomes were for mean operative time, which was 139.5 minutes (range 94 to 213) in the laparoscopic group and 122.5 minutes (83 to 239) in the open group (p <0.01), and mean length of stay, which was 25.9 hours (18 to 143) in the laparoscopic group and 28.2 hours (16 to 73) in the open group (p = 0.02). Analgesic usage, success rate, total charges and all parameters in children older than 11 years were similar between the groups. Conclusions: Open and laparoscopic dismembered pyeloplasty are comparable and effective methods for repair of ureteropelvic junction obstruction. Although operative time was statistically shorter in the open group and length of stay was shorter in the laparoscopic group, the clinical significance of these variables is questionable. The approach to repair may best be based on family preference for incision aesthetics and surgeon comfort with either approach, rather than more classically objective outcome measures. References 1 : Retrocaval ureter; a case diagnosed pre-operatively and treated successfully by a plastic operation. Br J Urol1949; 21: 209. Google Scholar 2 : Transperitoneal laparoscopic pyeloplasty in children. J Endourol2007; 21: 1461. Google Scholar 3 : An updated meta-analysis of laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children. Int J Clin Exp Med2015; 8: 4922. Google Scholar 4 : Laparoscopic versus open pyeloplasty in children: preliminary report of a prospective randomized trial. J Urol2010; 184: 690. Link, Google Scholar 5 : Fundamentals of laparoscopic and robotic urologic surgery. In: Campbell-Walsh Urology, 11th ed. Edited by . Philadelphia: Elsevier2016. chapt 10. Google Scholar 6 : Laparoscopic transabdominal pyeloplasty in children is feasible irrespective of age. J Urol2006; 175: 688. Link, Google Scholar 7 : Laparoscopic pyeloplasty. J Urol1993; 150: 1891. Link, Google Scholar 8 : Laparoscopic dismembered pyeloplasty. J Urol1993; 150: 1795. Link, Google Scholar 9 : Laparoscopic Anderson-Hynes dismembered pyeloplasty in children. J Urol1999; 162: 1045. Link, Google Scholar 10 : Laparoscopic pyeloplasty compared with open pyeloplasty in children. J Endourol2007; 21: 897. Google Scholar 11 : Co