Laparoscopic repyeloplasty after failed open repair of ureteropelvic junction obstruction: a case-matched multi-institutional study

Abstract

Laparoscopic repyeloplasty is a safe and viable treatment option for secondary UPJO, with a success rate similar to that of primary repair but with longer operative time. Considerable experience in laparoscopic reconstructive procedures is a prerequisite for optimal results.

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

“…[ 9 10 11 12 13 14 ] Of the six retrospective studies, two used prospectively collected data. [ 11 14 ] Two studies were from North America,[ 11 14 ] two from Egypt,[ 9 10 ] one from India,[ 13 ] and one from Brazil. [ 12 ] One publication reported matching numbers of patient groups for age and surgical procedure, and all of them were based on a single-surgeon experience.…”

“…Of the six studies that assessed operative time, two showed similar operative time for RLP and ROP,[ 10 13 ] two indicated that OP time was shorter than RLP time[ 9 12 ] (with an insignificant difference in one study[ 12 ]), and two revealed that RLP operative time was insignificantly shorter than OP time. [ 11 14 ] The meta-analysis of six studies showed that ROP was associated with a 12-min reduction of operative time (random effects model; WMD: 12.7 min; 95% confidence interval [CI] 24.6–3; P = 0.14).…”

“…Of the six studies that analyzed the LOS, four reported that RLP was associated with a shorter hospital stay,[ 9 11 12 14 ] while two showed no difference between the two approaches. [ 10 13 ] The meta-analysis of extractable data from all studies demonstrated a significantly shorter hospital stay after RLP than after ROP (random effects model; WMD: 0.6 days; 95% CI: 0.6–0.4; P < 0.01), subtotal (95% CI), and WMD = −0.49 (−0.57, −0.41), test for heterogeneity: χ 2 = 8.00, df = 3 ( P < 0.01), I 2 = 47.8%, test for overall effect: Z = 18.36 ( P = 0.004), as shown in Figure 3 .…”

“…Of the six studies that appraised complication rate, three had similar complication rates for both procedures. [ 11 13 14 ] Three showed slightly higher complication rates after ROP,[ 9 10 12 ] and no study reported more complications following RLP; all differences were statistically significant. The meta-analysis of these six studies showed that both procedures had similar complication rates (random effects model, OR: 0.8; 95% CI: 0.3–1.6; P = 0.50), total events: 11 laparoscopic, 13 open pyeloplasty, test for heterogeneity: χ 2 = 4.05, df = 8 ( P < 0.91), I 2 = 0%, test for overall effect: Z =0.76 ( P = 0.50), as shown in Figure 4 .…”

“…After the process of selection and review, six studies were used[ 9 10 11 12 13 14 ] [ Figure 1 ], with 97% approval among reviewers. Any disagreement was resolved by unanimity between reviewers.…”