Laparoscopic pyeloplasty versus open pyeloplasty for recurrent ureteropelvic junction obstruction in children.
OBJECTIVE
Recurrent ureteropelvic junction obstruction (UPJO) in children is an operative challenge. Minimally invasive endourological treatment options for secondary UPJO have suboptimal success rates; hence, there is a re-emergence of interest about redo pyeloplasty. The present study presented experience with laparoscopic management of previously failed pyeloplasty compared with open redo pyeloplasty in children.


METHODS
Twenty-four children with recurrent UPJO who underwent transperitoneal dismembered laparoscopic pyeloplasty were studied. Operative, postoperative, and follow-up functional details were recorded and compared with those of open pyeloplasty (n = 15) carried out for recurrent UPJO by the same surgeon during the same study period.


RESULTS
Demographic data were comparable in the laparoscopic and open groups, except for a significantly lower GFR in the open group (24.8 vs 38.2 ml/min, P = 0.0001). Mean time to failure of the original repair was 20.2 months (23.6 months for redo laparoscopic pyeloplasty, 18.8 months for redo open). The success rate of laparoscopic redo pyeloplasty was 91.7 vs 100% in open redo pyeloplasty. Compared with redo open pyeloplasty, the mean operative time was longer (211.4 ± 32.2 vs 148.8 ± 16.6, P = 0.002), estimated blood loss was higher (102 vs 75 ml, P = 0.06), while hospital stay was shorter and pain score was lower in the laparoscopy group (P = 0.02) in the laparoscopic group. There were no intraoperative complications, while the postoperative complication rate was similar in the two groups (20.8 vs 20.0%).


CONCLUSIONS
Before the laparoscopic approach became a viable option, endopyelotomy was widely used for managing recurrent UPJO. However, the success rate of endopyelotomy for secondary UPJO was approximately 10-25% lower than for open pyeloplasty. Redo pyeloplasty had excellent results, with reported success rates of 77.8-100%. Laparoscopic redo pyeloplasty is becoming a viable alternative to open redo pyeloplasty in many centers with experience in minimally invasive techniques. The present study revealed that redo laparoscopic pyeloplasty appeared to have advantages over redo open surgery, in that it was associated with shorter hospital stay (4 vs 6 days, P = 0.046), reduced postoperative pain score (P = 0.02), and less need for postoperative analgesia (P = 0.001), still with comparable successful outcomes and patient safety. However, the procedure had a longer operative times and more blood loss.


CONCLUSIONS
Laparoscopic pyeloplasty is a viable alternative to open pyeloplasty in children with recurrent UPJO, with shorter hospital stays and less postoperative pain. However, the procedure is technically demanding and should be attempted in high-volume centers by laparoscopists with considerable experience in laparoscopic reconstructive procedures.
Alexandria University, Egypt. Electronic address: alym_68@yahoo.com.
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AM
Abdel-Karim
Alexandria University, Egypt.
A
A
Fahmy
Alexandria University, Egypt.
A
A
Moussa
Alexandria University, Egypt.
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H
Rashad
Elmenia University, Egypt.
M
M
Elbadry
Alexandria University, Egypt.
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H
Badawy
Sohag University, Egypt.
A
A
Hammady
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000151:congenital* / Q000601:surgery; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D021782:Multicystic Dysplastic Kidney / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
Children; Failed pyeloplasty laparoscopy; Open repair; UPJO; Ureteropelvic junction obstruction