Comparison of Laparoscopic-assisted Versus Open Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction in Infants: Intermediate Results

Abstract

To compare the results of laparoscopic-assisted dismembered pyeloplasty (LADP) with open dismembered pyeloplasty in infants. LADP is an innovative minimally invasive technique to mobilize and exteriorize the ureteropelvic junction for Anderson-Hynes dismembered pyeloplasty. A total of 23 infants (mean 7.3 months, range 2-11) underwent LADP via the retroperitoneal approach. An additional 21 children (mean 8.2 months, range 3-12) underwent similar procedures via open surgery. We retrospectively compared the operative time, hospital stay, postoperative complications, and follow-up. Patient demographic data were similar between the 2 groups. Mean operative time was significantly shorter in the open surgery than the LADP group (95.4 vs 102.6 minutes, P <.05). The mean incision length (2 vs 5 cm), recovery of intestinal function (24.3 vs 48.2 hours), and postoperative hospital stay (2.5 vs 5 days) were better in the LADP group than in the open group (P <.01). No intraoperative complications occurred in either group. Mean follow-up was 19 (range 6-36) and 24 (range 12-48) months in the LADP and open surgery groups, respectively. The incidence of postoperative complications (3 of 23, 13.0% vs 3 of 21, 14.3%; P = .33) and success rates (22 of 23, 95.7% vs 20 of 21, 95.2%; P = .51) were equivalent in the 2 groups. Shorter hospital stay, early recovery, and better cosmetic results may be the advantages of LADP over open surgery in small infants, which should be confirmed by a prospective and randomized study.