Laparoscopic redo pyeloplasty in children: comparison with laparoscopic primary pyeloplasty

Abstract

Laparoscopic pyeloplasty has become fairly established in children. However, there are only a few reports on the use of laparoscopy for redo pyeloplasty. Laparoscopic redo pyeloplasty for previously failed open pyeloplasty can be quite challenging, due to the extensive adhesions and fibrosis following the previous operation. In this paper, we compare our experience with laparoscopic primary pyeloplasty with laparoscopic redo pyeloplasty after previous failed open pyeloplasty in children. We retrospectively reviewed all pediatric laparoscopic pyeloplasties performed by a single surgeon over a 2-year period. Data were retrieved from operative and follow-up records. Patients undergoing primary pyeloplasty were compared to those undergoing redo pyeloplasty. Clinical, operative and follow-up data were compared between the two groups. Ultrasound examination was repeated 3–6 months after the surgery; success of pyeloplasty was defined as absence of symptoms and improvement in hydronephrosis compared with pre-operative testing. Statistical analysis was done using software; Mann-Whitney U test and Fisher exact test were used where applicable, and p < 0.05 was considered significant. Of 104 laparoscopic pyeloplasties, 95 were primary and 9 redo pyeloplasties. All redo pyeloplasties had previous failed open pyeloplasty done elsewhere (once in 7 and twice in 2). Laparoscopic pyeloplasty was done using three ports, with antegrade double J stent placement at the time of pyeloplasty, which was removed after 4–6 weeks. The comparison between the two groups is given in Table 1. The mean age at surgery and the laparoscopic operative time was significantly higher (40% higher) in children undergoing redo pyeloplasty. The length of stay and post-operative complications were not significantly different between both the groups. At follow-up, laparoscopic pyeloplasty was considered successful in 74/74 (100%) primary and 9/9 (100%) redo pyeloplasties. In this large single-surgeon series, laparoscopic redo pyeloplasty for previous failed open pyeloplasty in children was found to be feasible, safe and effective, comparable to primary laparoscopic pyeloplasty. However, even in expert hands, the operating time was significantly more for redo cases.