A Randomized Trial on Surgical Outcomes of Open and Laparoscopic Pyeloplasty in Pelviureteric Junction Obstruction in Pediatric Patients: Is It Time to Conclude the Debate?

Abstract

Objective:Pyeloplasty involves the surgical reconstruction of the pelviureteric junction (PUJ) to drain the urine. We compared the surgical outcomes of open and laparoscopic pyeloplasty (LP) in PUJ obstruction in pediatric patients.Materials and Methods:A simple randomized, prospective, comparative trial was conducted at two tertiary care centers in North India, from Jan 2015 to Dec 2019, with a follow-up to Dec 2020. A total of 110 patients were included in the study, out of which 52 underwent LP, and 58 were offered open pyeloplasty (OP).Results:The mean operative time in the OP and LP groups was 100 min (80-140 min) and 170 min (120-240 min), respectively. The mean blood loss in the OP and LP groups was 15 mL and 10 mL. In the OP group, pre-operative mean split renal function was 33.5% (19-40%), which increased to 40.5% (27-46%) postoperatively. In the LP group, pre-operative mean split renal function was 35% (23-39%), which increased to 45.5% (30-48%) post-operatively after one year at the first follow-up scan. The mean number of analgesic doses administered was 12 (range 9-15 doses) in the OP group and 9 (range 7-12 doses) in the LP group.Conclusion:LP and OP showed no significant differences except for operative time. The analgesic requirement was higher in the OP group without being statistically significant. Both techniques were equally effective, and any procedure being superior to others in all respects is ill-founded and must be viewed with an unbiased approach.

Keywords

• pelviureteric junction obstruction
• laparoscopic pyeloplasty
• open pyeloplasty
• puj obstruction