Population‐based comparison of laparoscopic and open pyeloplasty in paediatric pelvi‐ureretic junction obstruction

Abstract

Objective• To describe the extent of use and in-hospital outcomes of open and laparoscopic pyeloplasty for paediatric pelvi-ureteric junction (PUJ) obstruction in the USA. Patients and Methods• Results• During the 5-year study interval, 4426 (96.4%) and 164 (3.6%) paediatric patients diagnosed with PUJ obstruction underwent open and laparoscopic pyeloplasty, respectively.• The proportion of patients undergoing laparoscopic pyeloplasty gradually increased from 2.4% in 2004 to 4.4% in 2008, but this increase was not significant (P = 0.22 for trend).• On multivariable analysis, laparoscopic pyeloplasty was observed to have rates of postoperative complications (2.51 vs 5.00; P = 0.67), LOS (2.42 vs 2.75; P = 0.33) and total hospitalization cost ($9755 vs $8537; P = 0.24) similar to those of open pyeloplasty. Conclusions• While laparoscopic pyeloplasty was generally an infrequent operation performed for paediatric PUJ obstruction during the period studied, this minimally invasive surgery provided similar outcomes in terms of in-hospital complications, LOS and total hospitalization costs.• The results of this study inform policymakers about the comparative effectiveness of laparoscopic and open pyeloplasty.

Giant hydronephrosis: still a reality!

“…Success rates were similar in laparoscopic and open pyeloplasty. This success rate in GH is lesser than post pyeloplasty in simple HDN (>93%) as reported by Knoedler et al [25] and Pohl et al [26] . Complication rate reported as 23.8 % in our series is higher than reported in simple HDN by Pohl et al [26] .…”

Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients

“…This is now the most common presentation of ureteropelvic junction (UPJ) obstruction. The most common etiology for infant hydronephrosis is UPJ obstruction which accounts for approximately 2.5/100,000 of the hospitalization per year (2)(3)(4). The majority of the hospitalizations occur in children less than 3 years old (5).…”

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

“…[9][10][11] In contrast to other minimal invasive techniques that have been established as standard of care such as laparoscopic appendectomy, the rather restrictive dissemination of LP might reflect the challenging character of this operation. 8,12 Moreover, a group from Rochester recently showed that the minority of LP takes place in non-teaching hospitals. 12 Against the background of a decentralized hospital system in Germany, this may contribute to the low percentage of LP in infants.…”

“…8,12 Moreover, a group from Rochester recently showed that the minority of LP takes place in non-teaching hospitals. 12 Against the background of a decentralized hospital system in Germany, this may contribute to the low percentage of LP in infants. 13 Accordingly, the mode of pyeloplasty may be chosen for the surgeons' discretion and experience instead of the available evidence.…”