Laparoscopic Versus Open Pyeloplasty: Comparison of Two Surgical Approaches- A Single Centre Experience of Three Years

Abstract

UPJO causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new technique must be compared. We analyzed the comparison of Laparoscopic and open pyeloplasty in a randomized prospective trial. A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 Laparoscopic and 34 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally. Standard open Anderson Hynes pyeloplasty, spiral flap or VY plasty was done depending on anatomic consideration. Patients were followed with DTPA scan at 3 months and IVP at 6 months. Perioperative parameters including operative time, analgesic use, hospital stay, and complication and success rates were compared. Mean total operative time with stent placement in LP group was 244.2 min (188-300 min) compared to 122 min (100-140 min) in open group. Compared to open pyeloplasty the post operative diclofenac requirement was significantly less in LP group (mean107.14 mg) and open group required mean of (682.35 mg) The duration of analgesic requirement was also significantly less in LP group. The post operative hospital stay in LP was mean 8.29 days (7-11) and was significantly less than open group (mean 3.14 Days (2-7 days). Open pyeloplasty has been the gold standard for UPJO repair and achieves success rates exceeding 90%. Laparoscopic pyeloplasty provides a minimally invasive alternative to repair UPJO and has developed world wide as the first minimally option to match success rate of open pyeloplasty. Its potential advantages including less post op pain, shorter hospital stay an improved cosmesis has been proved in some comparative series. The only disadvantage seems to be longer operative time. LP has a minimal level of morbidity and short hospital stay compared to open approach Although Laparoscopic pyeloplasty has the disadvantages of longer operative time and requires significant skill of intracorporeal knotting but it is here to stay and represents an emerging standard of care.

Comparison of surgical and functional outcomes of open, laparoscopic and robotic pyeloplasty for the treatment of ureteropelvic junction obstruction

“…However, mean hospital stay was shorter than that of the RP (p=0.047). In a study conducted by Bansal et al [20] lesser amount of postoperative analgesic requirement was reported in LP patients relative to open pyeloplasty (mean, 107.14 mg vs 682.35 mg, p<0,01). Besides in the same study, mean hospital stay was reported as 8.29 days in open pyeloplasty, and 3.14 days in the LP group (p<0.01).…”

“…In a study conducted by Bansal et al [20] in 2011, the investigators determined mean operative times in patients who had undergone LP, and open pyeloplasty as 244, and 122 minutes, respectively (p<0.01). In this study where Bansal et al compared LP with open method, and emphasized longer operative time of LP as the only disadvantage of this approach.…”

Variation in the Use of Open Pyeloplasty, Minimally Invasive Pyeloplasty, and Endopyelotomy for the Treatment of Ureteropelvic Junction Obstruction in Adults

“…2 Endopyelotomy is a third option that is less invasive than both the open and minimally invasive pyeloplasties. 3 While all these treatments are effective, [3][4][5][6] the extent to which they are used is unclear. Although recent studies have shown a rapid increase in the use of minimally invasive pyeloplasty, many of them only compare inpatient procedures (i.e., open and minimally invasive pyeloplasty) and exclude outpatient treatments (i.e., endopyelotomy).…”

Trends in the Treatment of Adults with Ureteropelvic Junction Obstruction

“…inimally invasive pyeloplasty is an effective treatment for patients with ureteropelvic junction obstruction that offers quicker convalescence, 1 decreased postoperative pain, 1,2 and improved cosmesis 3 compared with the conventional open pyeloplasty. With success rates greater than 90%, minimally invasive pyeloplasty has equivalent outcomes to those of open pyeloplasty 4 and superior outcomes to those of endopyelotomy.…”