Abstract
We compare open pyeloplasty (OP) versus laparoscopic pyeloplasty (LP) in children in a multicenter, prospective, case-control study. From 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. Fifteen 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. In 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.
Highlights
Open pyeloplasty (OP) remains as the gold standard to repair ureteropelvic junction obstruction (UPJO) in children [1]
The other four patients were excluded from the Laparoscopic pyeloplasty (LP) group: associated kidney stones; solitary kidney and conversion to open surgery, one each
Antenatal hydronephrosis was the form of presentation in six and three patients in the LP and OP groups, respectively (p = 0.32)
Summary
Open pyeloplasty (OP) remains as the gold standard to repair ureteropelvic junction obstruction (UPJO) in children [1]. Other techniques of minimally invasive surgery (MIS) like robotic-assisted LP, single site LP (SSLP), or laparoscopicassisted pyeloplasty have demonstrated satisfactory results as well [11,12,13]. Well-designed prospective studies and randomized controlled trials comparing OP and LP are scant [14, 15] with contradictory results with regards to patient recovery. The aim of the present study was to compare LP versus OP for primary repair of UPJO in children in a multicenter, prospective, case–control study. We hypothesize that using the same postoperative setup for the two techniques and a standardized protocol for administration of pain medication and patient discharge, patients undergoing LP would have a faster recovery
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