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Introduction <p>Open pyeloplasty (OP) has been the gold standard technique for decades. However, retroperitoneoscopic pyeloplasty (RP) has received popularity because of its minimally invasive nature sparing entry to the peritoneal cavity. There has been some research which suggests that patients undergoing laparoscopic pyeloplasty have shorter hospital stays (1), reduced analgesic requirement and a better esthetic outcome in comparison to the open operation (2). Reported complication rates are typically similar. RP is technically difficult, particularly in smaller patients, but reduces the risk of ileus, bowel injury and contains any potential anastomotic leak (3). Interestingly, the benefits of minimally invasive pyeloplasty demonstrated in older children do not always hold true for younger cohorts (2,4). Performing pyeloplasty early in life is essential to proactively safeguard against the potential decline of kidney function. Through this study, we explore the efficacy and safety of retroperitoneal laparoscopic pyeloplasty compared to open pyeloplasty in children younger than one year of age. Retroperitoneal laparoscopic pyeloplasty was introduced at our centre in 2019 and is performed on children of all ages. While both procedures have been validated to be effective in older children, there is a paucity of data with respect to retroperitoneal laparoscopic pyeloplasty in younger children. This study aims to bridge this gap by comparing results of each technique at this unique age.</p> Patients and methods <p>Following registration with the hospital quality improvement team, data were collected for all patients under 12&#xa0;months of age who underwent pyeloplasty between the period of January 2019 and March 2023. Patients were excluded if their follow-up ultrasound scan was not complete at the point of data collection. Patients were identified from the operative database and crosschecked with surgeons’ logbooks. Demographic and outcome data were identified from the electronic patient record and analyzed using Chi squared and Mann–Whitney u-test in Excel. Surgical intervention was indicated in infants with PUJO and: progressive hydronephrosis on ultrasound, declining renal function on renogram of more than 10%, or urinary tract infections (5). Per Valla et al. surgery was deemed successful if symptoms improved, pelvic/calyceal dilatation decreased on ultrasonography, or renal drainage/function improved renographically (6).</p> Results <p>Thirty four patients underwent 35 pyeloplasties between January 2019 and March 2023. Open pyeloplasty was performed in 24 (68.6%) and retroperitoneal laparoscopic pyeloplasty in 11 (31.4%). See for Table&#xa0;<InternalRef RefID="Tab1">1</InternalRef> demographic and outcome data.</p>

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Single centre, retrospective comparative study: Is laparoscopic retroperitoneal pyeloplasty in children under 1 year of age comparable to open pyeloplasty?

  • 期刊论文

  • 发表日期：

    2025年2月20日

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  • Ahmad Alaqqad,
  • Georgina Bough,
  • Grace Watt,
  • Sengamalai Manoharan,
  • Ewan Brownlee,
  • Stephen Griffin

摘要

Introduction

Open pyeloplasty (OP) has been the gold standard technique for decades. However, retroperitoneoscopic pyeloplasty (RP) has received popularity because of its minimally invasive nature sparing entry to the peritoneal cavity. There has been some research which suggests that patients undergoing laparoscopic pyeloplasty have shorter hospital stays (1), reduced analgesic requirement and a better esthetic outcome in comparison to the open operation (2). Reported complication rates are typically similar. RP is technically difficult, particularly in smaller patients, but reduces the risk of ileus, bowel injury and contains any potential anastomotic leak (3). Interestingly, the benefits of minimally invasive pyeloplasty demonstrated in older children do not always hold true for younger cohorts (2,4). Performing pyeloplasty early in life is essential to proactively safeguard against the potential decline of kidney function. Through this study, we explore the efficacy and safety of retroperitoneal laparoscopic pyeloplasty compared to open pyeloplasty in children younger than one year of age. Retroperitoneal laparoscopic pyeloplasty was introduced at our centre in 2019 and is performed on children of all ages. While both procedures have been validated to be effective in older children, there is a paucity of data with respect to retroperitoneal laparoscopic pyeloplasty in younger children. This study aims to bridge this gap by comparing results of each technique at this unique age.

Patients and methods

Following registration with the hospital quality improvement team, data were collected for all patients under 12 months of age who underwent pyeloplasty between the period of January 2019 and March 2023. Patients were excluded if their follow-up ultrasound scan was not complete at the point of data collection. Patients were identified from the operative database and crosschecked with surgeons’ logbooks. Demographic and outcome data were identified from the electronic patient record and analyzed using Chi squared and Mann–Whitney u-test in Excel. Surgical intervention was indicated in infants with PUJO and: progressive hydronephrosis on ultrasound, declining renal function on renogram of more than 10%, or urinary tract infections (5). Per Valla et al. surgery was deemed successful if symptoms improved, pelvic/calyceal dilatation decreased on ultrasonography, or renal drainage/function improved renographically (6).

Results

Thirty four patients underwent 35 pyeloplasties between January 2019 and March 2023. Open pyeloplasty was performed in 24 (68.6%) and retroperitoneal laparoscopic pyeloplasty in 11 (31.4%). See for Table 1 demographic and outcome data.