Transperitoneal Laparoscopic Pyeloplasty versus Laparoscopic Assisted Pyeloplasty for the Treatment of Ureteropelvic Junction Obstruction in Children

Abstract

Background: Laparoscopy-assisted pyeloplasty [LAP] has been introduced to shorten the operative time and make the traditional transperitoneal laparoscopic pyeloplasty [LP] much easier while maintaining comparable functional and cosmetic results to the LP. Purpose: Comparing the outcomes of LP to LAP in terms of operative time and cosmetic appearance. Patients and Methods: This is a randomized controlled study where twenty patients presented with ureteropelvic junction obstruction [UPJO] were divided into two equal groups. The first was subjected to LP while the second was subjected to LAP. The outcome measurements included the operative time, the hospital stay, intraoperative complications, and the success rates. Postoperative data were collected with special emphasis on pain and analgesia requirements. Results: The mean age of the patients was 4.95 ±3.7 years [range=9 months to 12 years], the preoperative SFU grade was 3.7 and the renal relative function was 25.5%. The mean operative time was 154±21 minutes [range =126 to 185 minutes] for LP compared to just 114±12 minutes [range =98 to 130 minutes] in LAP (p < 0.001). The success rate was 90% in both groups and the postoperative split function rose to around 40%. Although the leakage was slightly higher in the LP, the wound complications were higher in the LAP group. The cosmetic results and patients’ satisfaction were in favor of LP. Conclusion: The success and recurrence rates are almost equal in both techniques. The main advantages of LAP over LP are the marked operative time reduction and its reproducibility by the less experienced laparoscopic surgeons.