Elsevier

Urology

Volume 101, March 2017, Pages 50-55
Urology

Pyeloplasty
Comparison of Laparoscopic Approaches for Dismembered Pyeloplasty in Children With Ureteropelvic Junction Obstruction: Critical Analysis of 11-Year Experiences in a Single Surgeon

https://doi.org/10.1016/j.urology.2016.10.007Get rights and content

Objective

The choice of different laparoscopic approaches of laparoscopic pyeloplasty (LP) in children remains controversial. We present a comparison of different approaches of LP in children and a critical analysis of 11-year experiences in a single surgeon.

Materials and Methods

There were 1750 patients (1889 sides) who underwent LP between 2003 and 2014 reviewed. The diagnosis and outcomes of ureteropelvic junction obstruction (UPJO) were reviewed based on clinical and imaging data. Retroperitoneal laparoscopic pyeloplasty (RPLP) were performed in 451 cases (RPLP group), conventional transperitoneal laparoscopic pyeloplasty (CTLP) were performed in 311 cases (CTLP group), transumbilical single-site laparoscopic pyeloplasty (TSLP) were performed in 322 cases (TSLP group), and transumbilical multiport laparoscopic pyeloplasty (TMLP) were performed in 805 cases (TMLP group). We assessed preoperative clinical data and outcomes, and analyzed the transition experience. Data are expressed as medians for continuous variables.

Results

The start of oral feeding, hospital stay, and the operative time of RPLP group were 1.10 ± 0.10 days, 5.22 ± 1.32 days, and 138.2 ± 20.1 minutes, respectively. Compared with the other 3 groups, the start of oral feeding was the soonest, hospital stay was the shortest, and the operative time was the longest in the RPLP group (P < .01 or .05). The cosmetic result of the TMLP group was 7.07 ± 1.20 scores, and there are significant differences in cosmetic results between the TMLP group and the other 3 groups (P < .05).

Conclusion

Although the 4 laparoscopic approaches for LP in children with UPJO are safe and efficient procedures with equivalent success rates, we recommend RPLP or TMLP as a treatment option for children with UPJO.

Section snippets

Patients

After the approval by institutional review board, we retrospectively summarized the clinical data of 1750 children with UPJO (1889 sides) aged 3 months to 14 years old who were enrolled between March 2003 and September 2014. Patients' details were recorded, including demographic data, clinical presentation, examination data, operative time, and clinical outcomes (Table 1, Table 2). All patients were diagnosed mainly on clinical presentation, ultrasound, and magnetic resonance urography. The

Results

The clinical data of the 1750 patients (including 1889 sides) were recorded. The patients' clinical data were comparable among the 4 groups without significant differences in demographics, clinical presentation, and preoperative imaging data (P > .05, Table 1). All procedures were performed successfully without serious intraoperative complications. No patient required additional trocar during operation. The operative time and clinical outcomes were compared among the 4 groups (Table 2). There

Comment

The present study is a retrospectively summarized design that compares 4 approaches of LP in children. Previous studies revealed that the learning curve of LP is 20-30 cases,16, 17 and usually the learning curve is defined by operative time and assessed along with the surgical outcomes. Although the choice of the surgical approach depends on anatomy, age, and clinical grades of patients, the surgeon's experience, technique, and preference are important to choose the surgical approach. In the

Conclusion

Four laparoscopic approaches for LP in children with UPJO are safe and efficient procedures with equivalent success rates. We recommend RPLP or TMLP as a treatment option for children with UPJO.

Acknowledgment

The authors thank Xu Zhang, M.D., Long Li, M.D., and Zheng Wei, M.D., for their contributions to this work.

References (24)

  • F. Greco et al.

    Laparoendoscopic single-site upper urinary tract surgery: assessment of postoperative complications and analysis of risk factors

    Eur Urol

    (2012)
  • A.R. Khawaja et al.

    Stentless laparoscopic pyeloplasty: a single center experience

    Urol Ann

    (2014)
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      Although both approaches had high success rates, the retroperitoneal approach was associated with a shorter operative time, shorter hospital stay, quicker recovery of intestinal movement, and earlier resumption of oral feeding compared with the transperitoneal approach.22 In a separate single-surgeon experience, Liu and colleagues23 compared outcomes using different laparoscopic approaches to pyeloplasty in 1750 children. Although not randomized, the investigators found that retroperitoneal LP had similar safety and efficacy compared with conventional transperitoneal and single-site transperitoneal LP.

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      As described previously, laparoscopic pyeloplasty is becoming a viable operation for children with ureteropelvic junction obstruction.19-21 Success rates and surgical outcomes of laparoscopic pyeloplasty in children have been reported to be equivalent to the open procedure including good functional outcome.22 However, there are still very few patients suffering second obstruction with long ureteral defect after pyeloplasty.

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    Financial Disclosure: The authors declare that they have no relevant financial interests.

    Funding Support: This work was supported by the National Public Welfare Industry Research Projects (No. 201402007) and Capital Health Development Research Fund (No.2016-2-5091).

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