Comparative analysis of 3 different approaches for Pediatric Pyeloplasty

PurposeAnderson Heynes dismembered pyeloplasty is the technique of choice for correction of ureteropelvic junction obstruction (UPJO) in children. The selection of surgical access is mostly driven by surgeon preference and can be performed laparoscopically, through a flank incision, or through a dorsal lumbotomy. A comparative analysis involving these 3 different approaches has not been previously reported.Material and MethodsA retrospective chart review was conducted for all patients who underwent pyeloplasty between Jan 2005 and Aug 2007. Of 53 laparoscopic pyeloplasties, we selected 29 performed by a single surgeon and compared them to 54 age matched cases who had an open approach (32 flank and 22 dorsal lumbotomy). Age at surgery, operative time, hospital stay, complication and failure rates were evaluated. Statistical analysis was performed using one-way ANOVA test.ResultsThe main RESULTS are displayed in the table below:variablesLap * (n = 29)Flank (n = 32)Dorsal (n = 22)p (Anova)Age (years)7.98.07.20.49Operative time (min)187.8163.9167.70.02Hospital stay (days)2.33.63.3< 0.001Complications (%)3 (10.3)1 (3.1)1 (4.5)0.39Failure/Redo (%)1 (3.4)1 (3.1)0 (0)0.67Follow-up (months)13.524.922.6-*Mean op. time for the last 10 laparoscopic cases was 155 min (shorter than open operative time).ConclusionsAlthough mean operative time was greater for the laparoscopic group versus open cases, mean hospital stay was significantly shorter. Laparoscopic surgical time gradually improved over time, reaching those of flank and dorsal lumbotomy patients. Overall, the success rate was similar for the 3 pyeloplasty approaches. Our data do not favour one particular surgical access over the others. Future studies on cosmesis and pain control may reveal more divergent outcomes for these 3 approaches.