Transperitoneal laparoscopic pyeloplasty for primary repair of ureteropelvic junction obstruction in infants and children: comparison with open surgery.

PURPOSE: Pediatric laparoscopic pyeloplasty to treat ureteropelvic junction obstruction has been reported to decrease hospitalization stay and the analgesic requirement compared to open pyeloplasty. It is not clear if all age groups benefit from this procedure. We compared primary laparoscopic and open pyeloplasty in infants and children. MATERIALS AND METHODS: We retrospectively reviewed the records of consecutive primary pyeloplasties at a single institution during a 4.5-year period. Demographic data, body measurements, presentation, indications for surgery, operation type, surgical time, complications, analgesia requirement, hospital stay and outcome were recorded. RESULTS: Patients were divided in the open pyeloplasty group of 41 and the laparoscopic pyeloplasty group of 37. The groups were similar with regard to sex and laterality. There were more patients 14 months or younger in the open pyeloplasty group. Mean surgical time was longer in laparoscopic pyeloplasty but it decreased significantly after the first 15 cases (each p <0.001). Hospitalization and postoperative analgesia requirements were similar in the 2 groups. There was a higher success rate for laparoscopic pyeloplasty in patients older than 14 months (p <0.05). In the open pyeloplasty group there were more re-interventions as well as a trend toward more complications and readmissions. CONCLUSIONS: Transperitoneal laparoscopic pyeloplasty was performed safely in all pediatric age groups with minimal morbidity and excellent short-term results. In our experience laparoscopic pyeloplasty in infants and children is more difficult and time-consuming surgery than open pyeloplasty. However, it may provide a better outcome with fewer complications and better cosmesis. Prospective studies are needed to confirm these results.