In an attempt to answer the above question, Gatti et al. undertook a randomised controlled trial between 2005 and 2014. All children aged 1 to 18 years of age requiring surgery for pelviureteric junction (PUJ) obstruction were enrolled. A total of 50 patients were enrolled into the laparoscopic group and 48 into the open group. One surgeon undertook the laparoscopic procedures and another four performed the open pyeloplasties. Follow-up was similar for the two groups (13.7 months in the laparoscopic group vs. 12.3 in the open group). The only significantly different outcomes were for mean operative time, which was 139.5 minutes (range 94-213) in the laparoscopic group and 122.5 minutes (83-239) in the open group, and mean length of stay, which was 25.9 hours (range 18-143) in the laparoscopic group and 28.2 hours (16-73) in the open group. Complication rate was not statistically significantly different. It was 6% in the laparoscopic group – two patients required repeat pyeloplasty for symptomatic recurrence and one underwent stent replacement due to blockage with calcific debris. In the open group, complication rate was 2% - one patient underwent redo pyeloplasty for continued symptoms. They conclude that both laparoscopic and open approaches to pyeloplasty are effective and comparable in many respects. Although operative time was statistically shorter in the laparoscopic group, the clinical significance of 17 minutes less in the operating theatre and two hours extra in the hospital are of questionable significance. Despite the two approaches being so similar, the authors did not study variables such as cosmesis or perioperative quality of life which might be important given the findings.
Which is better – laparoscopic or open paediatric pyeloplasty?
Reviewed by Neil Featherstone
Laparoscopic vs open pyeloplasty in children: results of a randomized, prospective, controlled trial.
CONTRIBUTOR
Neil Featherstone
Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).
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