title: Comparative, Prospective, Case-Control Study of Open versus Laparoscopic Pyeloplasty in Children with Ureteropelvic Junction Obstruction: Long-term Results.
abstract: BACKGROUND
  We compare open pyeloplasty (OP) versus laparoscopic pyeloplasty (LP) in children in a multicenter, prospective, case-control study.
  
  
  METHODS
  From May 2007 to March 2009, a program was established at Hospital Garrahan, the reference center, to perform LP with a mentoring surgeon that would attend the institution once a month. Every new case of ureteropelvic junction obstruction (UPJO) diagnosed in the reference institution was offered to participate in the study. If the patient was enrolled, it was scheduled for LP. The following patient diagnosed with UPJO was operated on with open technique and served as a case-control. In three other facilities, patients were only offered LP and had a matched control open case at the reference institution. The first end point of the study was patient recovery: analgesia requirement and length of hospitalization (LOH). The second end point of the study was resolution of UPJO in long-term follow-up for the two techniques. Demographic data, surgical time, perioperative complications, analgesia requirement, analgesia score during hospitalization, LOH, and outcome were recorded. Both groups received the same postoperative indications for pain control. Parents were asked to assess pain in their children every 4 h postoperatively and to complete a pain scale chart to which the nurses were blinded.
  
  
  RESULTS
  Fifteen OP and 15 LP were compared. Groups were similar with regard to sex, age, weight, and laterality. Mean surgical time was longer in LP than in OP group (mean 188 versus 65 min) (p< 0.01). Hospitalization was shorter for LP group with a mean of 1.9 versus 2.5 days for OP group (p< 0.05). Postoperative analgesia requirement was significantly higher in the OP group with a mean use of morphine of 1.7 versus 0.06 mg/kg in the LP group (p< 0.05). Pain scores were similar in both the groups. At a mean follow-up of 58 months there were no failures.
  
  
  CONCLUSIONS
  In this prospective comparative cohort, LP was a longer procedure than OP. Both procedures had the same efficacy and complication rates, but patients undergoing LP needed fewer narcotics for pain control and had a shorter hospitalization.
authors.affiliation: Division of Pediatric Urology, Hospital IGA Dr. José Penna, Hospital Italiano Regional del Sur, Hospital Privado Dr. Raúl Matera , Bahía Blanca , Argentina.
authors.forename: Lisandro A
authors.initials: LA
authors.lastname: Piaggio
authors.affiliation: Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Corbetta
authors.affiliation: Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina.
authors.forename: Santiago
authors.initials: S
authors.lastname: Weller
authors.affiliation: Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina.
authors.forename: Ricardo Augusto
authors.initials: RA
authors.lastname: Dingevan
authors.affiliation: Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina.
authors.forename: Víctor
authors.initials: V
authors.lastname: Duran
authors.affiliation: Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina.
authors.forename: Javier
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Lopez
keywords: children; comparative; laparoscopic pyeloplasty; long-term results; open pyeloplasty; prospective; randomized; ureteropelvic obstruction