Results of laparoscopic pyeloplasty in children with hydronephrosis caused by external and internal causes

Justification. The purpose of this scientific work is to analyze and compare the results of laparoscopic pyeloplasty in infants with external and internal causes of obstruction of pyeloureteral segment. Materials and methods. This retrospective study is based on an analysis of data from 120 patients who were performed laparoscopic operations for congenital hydronephrosis in the conditions of the neonatal surgery department of the Ivano-Matreninskaya children’s clinical hospital in Irkutsk from 2010 to 2020. A total of 125 laparoscopic pyeloureteral anastomoses were performed, taking into account bilateral lesions in 5 patients. The main group (group I) included 15 patients (15 operations) with renovascu-lar hydronephrosis. The control group (group II) consisted of 105 patients (110 operations), in whom the obstruction of the pyelo-ureteral segment was caused by internal stenosis of the ureter. In the course of the study, patient parameters related to demographic data, indicators of perioperative diagnostic studies, details of the operation, the results of recovery after surgery and the complications such as anastomotic leakage, recurrence and / or loss of kidney function were recorded. Results. The demographic data of patients with hydronephrosis did not differ in the comparison groups. The median age of patients was 41.00 [18.8; 71.3] days in group I versus 50.0 [25.3; 86.3] days in group II (p=0.361), body weight — 4350.0 [3775.0; 5450.0] grams versus 4325.0 [3600.0; 5800.0] grams (p=0.917). The duration of operations was comparable in the compared groups (p=0.395). The time required for laparoscopy in patients with renovascular occlusion was 60.0 [60.0; 85.0] min (min— max: 50.0—95.0 min), with internal stenosis of the pyeloureteral segment — 70.0 [60.0; 85.0] min (min—max: 40.0—120.0 min). The median length of hospital stay for patients with renovascular occlusion was 4 days (range: 3—6 days) and for children with internal obstruction of pyeloureteral segment, 4 days (range: 2—33 days). The frequency of early postoperative complications of laparoscopic pyeloplasty was lower in the group of patients with external type of pyeloureteral segment obstruction, but had no statis-tical differences (0 vs. 3.6 [1.0; 9.0]%; p=1.000). Ultrasound examination performed 3 months after the operation showed a statis-tically significant decrease in the anteroposterior diameter of the pelvis to 8.0 [6.0; 10.0] mm (min—max: 0.0—12.0 mm) in group I and to 8.0 [6.0; 10.0] mm — in group II (min—max: 0.0—20.0 mm) (p<0.001). The effectiveness of laparoscopic pyeloplasty in group I was 93.3 [68.1; 99.8]%, in group II — 98.2 [93.6; 99.8]% (p=1.000). Conclusion. Laparoscopic pyeloplasty in patients with external and internal hydronephrosis is accompanied by comparable early and late postoperative results.