Comparative Study Between Anderson-Hynes Pyeloplasty Through Transperitoneal Laparoscopic Approach Versus Vertical Lumbotomy Approach in UPJO Repair

Abstract

Background: Since 1949 dismembered pyeloplasty technique which was introduced by Anderson and Hynes has been the gold standard for the surgical correction of UPJO. And for decades Laparoscope has been the preferred approach. However, in Egypt -like many other developing countries-there is a limitation of laparoscopic interventions due to the limited number and distribution of laparoscopic sets. This limited availability forced many urologists in general hospitals to refer UPJO patients to tertiary centers and university hospitals, which added more burden on the already exhausted facilities. Objective: In this paper, we tried to explore options available to urologists who are working in areas where laparoscopic sets aren't available. We suggested the vertical lumbotomy approach to be explored in this study. Method: The study was conducted at El Demerdash Hospital in 2016. It included 20 patients with symptomatic UPJO. Patients were allocated to the 2 groups, 10 patients each using the closed envelop method. Results: Significantly shorter hospital stay in the vertical lumbotomy group. No statistically significant differences were noted between the studied group regarding postoperative pain, frequency of irritative LUS, hematuria, and pyuria. Study limitations: There were limitations of the study that might have affected its results such as the experience caliber of both teams, there were no unified preset criteria for post-operative management and there wasn't enough data about the learning curve of each approach. Conclusion: The laparoscopic approach for correction of UPJO is still the gold standard, however in some areas in developing countries which might be deprived of enough laparoscopic sets, the vertical lumbotomy approach can be utilized after proper training. This study results shouldn't be applied in hospitals where the laparoscopic approach is established for UPJO surgery.