Laparoscopic versus open pyeloplasty for management of secondary ureteropelvic junction obstruction

Abstract

Background: Ureteropelvic junction obstruction (UPJO) causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new techniques must be compared. Objective: To evaluate the laparoscopic management of secondary pelvi-ureteric junction obstruction regarding the operative time. Bleeding requiring blood transfusion intraoperative complication, hospital stays short-and long-term complication, and the rate of success in comparison to open repair in literature. Patients and methods: This study was conducted at the Urology Department of Aswan and Sohag University Hospitals. In the period from April 2016 to April 2020, a total of forty-five patients with secondary PUJ obstruction fulfilling the inclusion criteria were admitted for undergoing laparoscopic pyeloplasty. Results: The median follow-up period was 24 months (6-36 months). The mean of operative time (LPP) was 154.9± 25.4 minutes, ranged from 80 to 185 minutes, and the mean of blood loss was 77.8±32.8 ml, ranged from 30 to 190 ml. The mean value of hospital stay of our patients was 3.8±1.2 days, ranging from 2 to 7 days, and the mean of follow-up was 5.6±2.15 months, ranged from 3 to 24 months. During the follow up there were three patients who experienced postoperative obstruction, our success rate was 93.3%. Conclusion: Laparoscopic pyeloplasty regarding cost-effectiveness, success rate, complications, and outcome the disadvantages of longer operative time of laparoscopi pyeloplasty, and the long learning curve, is more superior to open pyeloplasty in shorter hospital stay, early convalescence, and low postoperative analgesic requirements.