Comparison of Cosmetic Results in Children >10 Years Old Undergoing Open, Laparoscopic or Robotic-Assisted Pyeloplasty: A Multicentric Study

Abstract

Purpose: Our goal was to compare surgical scars assessed by a validated patient reported outcome questionnaire in children undergoing open (OP), laparoscopic (LP), or robotic-assisted (RALP) pyeloplasty. Our secondary aim was to assess the influence on the outcomes of variables such as gender or body mass index (BMI). Materials and Methods: We conducted an observational, cross-sectional, multicentric study of patients undergoing primary pyeloplasty between age 10 and 18 years at 5 tertiary Italian institutions during the period January 2010 to December 2019. Of 227 eligible patients 114 (50%) participated. OP was performed in 37 (32%), LP in 30 (26%) and RALP in 47 (41%), After a median (IQR) followup of 5.2 (2.3e7.8) years, scars were measured and assessed by a validated Patient Scar Assessment Questionnaire. Scores were compared among techniques and in accordance with several variables. Results: The median length of the surgical scar at followup was significantly larger (p <0.0001) after OP (8.1 cm vs 1.8 cm for LP and 2.0 cm for RALP), where scar length correlated with BMI (p[0.04). Ninety patients (79%) had a Patient Scar Assessment Questionnaire score within the first quartile, the most favorable. During followup, 43 (38%) participants reported scar-related symptom. Symptoms were generally more common after OP (54% vs 30% for LP and 30% for RALP, p[0.06) and scar hyperesthesia was significantly more frequent after OP (p[0.01). Conclusions: Perception of the cosmetic outcomes in pre-adolescents and adolescents after pyeloplasty was generally good. LP achieved the best cosmetic results. OP was more commonly associated with scar-related symptoms and the size of the incision paralleled BMI.

Surgical approach to the treatment of urinary tract anomalies

“…Najčešće se koristi pijeloplastika po metodi HynesAnderson kojim se resecira pije loureterični vrat, reducira prekomjerno dilatirani pije lon i anastomozira ureter s pijelonom. Postupak se može izvesti otvoreno i laparoskopski, a u najnovije vrijeme i pomoću robotske kirurgije 17 . Endoskopski se može učiniti incizija pijeloureteričnog vrata, dilatacija balonom i sl.…”

Incision Looks, to Whom It May Concern: Parents, Patient or Surgeon?

“…Ultimately, it is reassuring that postsurgical patient satisfaction with their scars was comparable between open, laparoscopy and robotic surgery in pyeloplasty. 1 It seems that if one has a successful surgical outcome and no knowledge of minimally invasive cosmetic outcomes, patient satisfaction with the cosmetic outcome of open surgery is generally good, a finding supported by another publication using a similar method to evaluate satisfaction. 7 Nevertheless, when discussing different surgical techniques used to address a medical problem, surgeons will likely mention success rates and possible complication rates to compare techniques.…”

“…Thus, their only basis for comparison is the scar they currently have versus the idea of having no scar. Based on the results presented, 1 we can certainly say that if the procedure is successful, it is likely that the patient will accept the scar and overall satisfaction will be good irrespective of technique. Yet, could patients and parents be more satisfied with a laparoscopic incision outcome if they knew about it or have seen how they look to have a basis for comparison?…”

“…Post-procedure validated questionnaires are a proven and effective form to research patient satisfaction about different outcomes, however outside the known inherent limitations to this type of research as discussed in the manuscript by Ghidini et al (page 1118) in this issue of The Journal. 1 There is 1 potential flaw when using them to compare cosmetic outcomes of different procedures, which is the fact that patients who underwent the open procedure are not aware of the laparoscopic counterpart cosmetic results. Thus, their only basis for comparison is the scar they currently have versus the idea of having no scar.…”

“…Such is the case for incision body location, which is likely a key factor. As discussed in the article, 1 the fact that the incision used for the open pyeloplasty was located to the flank and out of the direct view of the patient looking down on their abdomen may have contributed to the good satisfaction scores. Two studies looked at satisfaction following the Hidden Incision Endoscopic Technique (HIdES) of port placement, where outside a hidden umbilicus port, the remaining laparoscopic ports are placed below the line of a Pfannenstiel incision.…”