Comparative, Prospective, Case–Control Study of Open versus Laparoscopic Pyeloplasty in Children with Ureteropelvic Junction Obstruction: Long-term Results

Abstract

IntroductionWe compare open pyeloplasty (OP) versus laparoscopic pyeloplasty (LP) in children in a multicenter, prospective, case–control study.Materials and methodsFrom May 2007 to March 2009, a program was established at Hospital Garrahan, the reference center, to perform LP with a mentoring surgeon that would attend the institution once a month. Every new case of ureteropelvic junction obstruction (UPJO) diagnosed in the reference institution was offered to participate in the study. If the patient was enrolled, it was scheduled for LP. The following patient diagnosed with UPJO was operated on with open technique and served as a case–control. In three other facilities, patients were only offered LP and had a matched control open case at the reference institution. The first end point of the study was patient recovery: analgesia requirement and length of hospitalization (LOH). The second end point of the study was resolution of UPJO in long-term follow-up for the two techniques. Demographic data, surgical time, perioperative complications, analgesia requirement, analgesia score during hospitalization, LOH, and outcome were recorded. Both groups received the same postoperative indications for pain control. Parents were asked to assess pain in their children every 4 h postoperatively and to complete a pain scale chart to which the nurses were blinded.ResultsFifteen OP and 15 LP were compared. Groups were similar with regard to sex, age, weight, and laterality. Mean surgical time was longer in LP than in OP group (mean 188 versus 65 min) (p < 0.01). Hospitalization was shorter for LP group with a mean of 1.9 versus 2.5 days for OP group (p < 0.05). Postoperative analgesia requirement was significantly higher in the OP group with a mean use of morphine of 1.7 versus 0.06 mg/kg in the LP group (p < 0.05). Pain scores were similar in both the groups. At a mean follow-up of 58 months there were no failures.ConclusionIn this prospective comparative cohort, LP was a longer procedure than OP. Both procedures had the same efficacy and complication rates, but patients undergoing LP needed fewer narcotics for pain control and had a shorter hospitalization.

Surgery for Pediatric Ureteropelvic Junction Obstruction—Comparison of Outcomes in Relation to Surgical Technique and Operating Discipline in Germany

“…Logistic regression analysis however revealed that the risk for complications was independent from the surgical technique applied and the age of the patients at surgery, which is in line with other reports. 15,26,31 Moreover, the frequency of re-do pyeloplasties (2.2%) as a main complication was comparable to that of others (3.1%) underlining the representativeness of our study cohort and the good quality of medical care for UPJO in Germany. 32 To date, there is no defined specialization for pediatric urology in Germany.…”

The outcomes of mini-laparoscopic pyeloplasty in children - brazilian experience

“…Although most series report longer operative time in LP, (mean 155-240min) (3,8,11,16) we had spent a mean of 107min., which may be near the open procedures time. Previous adult experience, same team, routine and focusing on simplifying every step certainly play a role in the operative time.…”

“…In spite of that, the argument of open procedure through small incisions has been still supported by some, who do not consider that even small scars grow with patients development and may cause dissatisfaction later. Concerning pain related to open small incision, it may be underestimated in small children (2,6,8,16).…”

Redo laparoscopic pyeloplasty among children: A systematic review and meta-analysis

“…Some studies showed that LP has the superiority, while other studies showed no extra benefits. [ 7 8 ] There are limited data that substantially uphold one type over the other. This meta-analysis study aimed to assess the feasibility and effectiveness of redo LP (RLP) versus that of redo open pyeloplasty (ROP) in children with SUPJO, in terms of operative time, LOS, success rate, and postoperative complications (urine leakage) and to evaluate the quality of proof in the literature and provide accurate clinical information.…”