Laparoscopic Versus Open Pyeloplasty for Pelvicoureteric Junction Obstruction: A Systematic Review and Meta-Analysis

Abstract

ObjectivesTo compare outcomes of laparoscopic versus open pyeloplasty for the management of pelvicoureteric junction obstruction (PUJO) using a systematic review and meta-analysis.In September 2022, electronic database searches were conducted using the Cochrane Library, the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, clinical trial registries, and relevant conferences to identify relevant abstracts and presentations.MethodsProspective randomized controlled trials comparing laparoscopic to open pyeloplasty for PUJO were included in the review. There were no restrictions on date or language. All populations were included. The authors performed data extraction and risk of bias assessment using the risk of bias tool. Meta-analysis was performed using RevMan software.ResultsSix prospective randomized controlled trials involving 335 participants were included in the analysis. Six studies included data on the failure rate, with a slight favouring of open pyeloplasty compared to laparoscopic pyeloplasty, although this was not statistically significant (odds ratio [OR], 1.39; 95% confidence interval [CI] 0.50 to 3.83).Five studies compared operative time, with open pyeloplasty found to have shorter times across all studies (mean difference [MD], 54.97 minutes; 95% CI 47.08 to 62.85).Based on 5 studies, laparoscopic pyeloplasty has a shorter hospital stay (MD, 4.12 days; 95% CI 3.64 to 4.59).Two studies compared postoperative analgesia requirements, showing a lower diclofenac requirement in the laparoscopic group (MD, 330.08 mg; 95% CI 298.05 to 362.11 mg).One study compared blood loss intraoperatively and found no significant difference between the groups (MD, 8.52 mL; 95% CI -2.49 to 19.53).Based on 4 studies, laparoscopic pyeloplasty may result in slightly higher complication rates postoperatively (OR, 1.49; 95% CI 0.53 to 4.18); however, there was no statistically significant difference.No subgroup analyses were conducted.ConclusionsLimited, low-quality evidence from small-scale trials suggests that laparoscopic pyeloplasty has improved outcomes in terms of shorter hospital stays and reduced postoperative pain compared to open pyeloplasty. Open pyeloplasty, on the other hand, had a shorter operative time. Failure rate, complication rate, and blood loss were comparable between the 2 approaches.