A comparison of laparoscopic and open pyeloplasty in treatment of congenital hydronephrosis on the example of 198 operations performed in infants of the first 3 months of life

Objective of the research: analysis and comparison of the results of laparoscopic (LP) and open pyeloplasty (OP) in patients with pyeloureteral segment obstruction (PSO). Materials and methods: a retrospective study based on an analysis of data from 191 patients of the first 3 months of life, that underwent surgical treatment for congenital hydronephrosis (HN) in the neonatal surgery department of the Irkutsk City Ivano-Matreninskaya Children's Clinical Hospital in 2005–2019. Considering bilateral renal damage in some patients, 198 LP and OP were performed. The main group (LP group) included 105 patients who underwent 110 LP, including simultaneous operations for bilateral HN in 5 patients. The control group (OP) included 86 patients who underwent 88 OP using posterior lumbotomy, including bilateral staged operations in 2 patients. During the study, patient parameters related to demographic data, indicators of perioperative diagnostic studies, details of surgery, results of recovery after surgery, and long-term consequences – relapse of the disease and/or loss of renal function were recorded. Results: the demographic data of patients with HN did not differ statistically significantly in the comparison groups. The duration of the surgery was significantly shorter in the laparoscopy group (p<0,001). The time required to perform surgery using laparoscopy was 73 minutes (range: 40–120 minutes), using open surgery – 91 minutes (range: 75–120 minutes). The average length of hospital stay after laparoscopic surgery was 4,19 days (range: 2–9 days), while in children after open operations the hospital stay was 8,95 days (range: 5–13 days). An ultrasound scan performed 3 months after surgery showed a significant decrease in the size of the pelvis on average to 8,48 mm (range: 0–38 mm) in the laparoscopy group and to 10,38 mm in the open surgery group (range: 0–45 mm). The incidence of early postoperative complications (urinoma formation) was comparable between the laparoscopic and open patient groups and had no statistical differences (3,6% versus 5,7%, p=0,439). Radionuclide renography revealed an improvement in the function of the operated kidney from 34% to 45% (p<0,001) in the laparoscopy group and from 32,3% to 44,6% (p<0,001) in the open surgery group. Recurrence occurred in 1 patient after laparoscopic pyeloplasty (0,9%) and in 4 patients after open pyeloplasty (5%). Loss of kidney function occurred in 1 patient after laparoscopy (0,9%) and 1 patient (1,1%) after open surgery. Thus, the efficiency of laparoscopic pyeloplasty in our series was 98,2%, and the OD was 94,3%. Conclusion: сomparison of laparoscopic and open pyeloplasty showed that laparoscopy can be safely and successfully performed even in young children with an acceptable level of complications comparable to the results of open operations. However, laparoscopy contributes to the accelerated recovery of patients and the favorable course of the postoperative period, devoid of many of the disadvantages of open surgery.