Retroperitoneal laparoscopic versus open pyeloplasty with a minimal incision: Comparison of two surgical approaches

Objectives. To compare the complications. hospital stay, and functional res ults of retroperitoneal laparoscopic (RL) pyeloplasty versus open pyeloplas ty (OP) with a minimal subcostal incision. Methods. From October 1997 to January 2000, 53 consecutive nonrandomized pa tients underwent 26 RL pyeloplasties, of which 1 was bilateral (group 1), a nd 28 OP (group 2). The decision between the two techniques depended on the patient's anesthetic ability to tolerate RL, previous ureteropelvic juncti on surgery, associated renal pathologic findings, and the surgeon's laparos copic experience. Subjective outcomes as to postoperative pain and convales cence and objective findings on intravenous urography were assessed at 3 mo nths postoperatively in both groups. Results. The mean operating time (165 versus 145 minutes) and mean blood lo ss (92 versus 84 mL) were similar in both groups. No intraoperative complic ations occurred in either group; in group 1, 1 patient required open conver sion. Postoperative complications occurred in 11.5% of group 1 and 14.3% of group 2. The mean hospital stay was 4.5 days for group 1 and 5.5 days for group 2. At 3 months, 23 patients (92%) in group 1 and 25 (89.2%) in group 2 were pain-free or improved. Intravenous urography showed a patent uretero pelvic junction in all cases and improvement of hydronephrosis in 88.5% of group 1 and 89.3% of group 2, Conclusions. The incidence of complications, hospital stay, and functional results were equivalent for RL pyeloplasty and OP with a minimal incision, but the return to painless activity was more rapid with laparoscopy in youn ger patients. UROLOGY 57: 443-447, 2001. (C) 2001, Elsevier Science Inc.