A comparative study of pediatric open pyeloplasty, laparoscopy-assisted extracorporeal pyeloplasty, and robot-assisted laparoscopic pyeloplastyReport as inadecuate




A comparative study of pediatric open pyeloplasty, laparoscopy-assisted extracorporeal pyeloplasty, and robot-assisted laparoscopic pyeloplasty - Download this document for free, or read online. Document in PDF available to download.

Purpose

To compare the outcomes of open pyeloplasty OP, laparoscopy-assisted extracorporeal LEXP, and robotic-assisted laparoscopic pyeloplasty RALP for ureteropelvic junction obstruction in pediatric patients.

Methods

We retrospectively reviewed the age-matched cohort of 30 children who underwent OP, 30 who underwent LEXP, and 10 who underwent RALP at a single institution, from 1996 to 2014. Pre- and post-operative variables including success rate were compared among surgical groups.

Results

The mean age of the patients was 120.2 months, the Society for Fetal Urology grade was 3.6, the anteroposterior diameter was 3.1 cm, and the renal relative function was 44.0%. The distribution of laterality, mean body mass index, and preoperative anteroposterior pelvic diameter on ultrasound did not differ among groups. The mean length of hospital stay was significantly shorter in the RALP group 3.2 days than in the OP 6.6 days and LEXP 5.8 days groups p<0.001. The duration of analgesics use was shorter in the RALP group 1.1 days than in the other groups p<0.001. During the mean follow-up period of 49.0, 20.1, and 16.6 months, the success rate was 96.7%, 89.7%, and 100% in the OP, LEXP, and RALP groups, respectively, although this difference was not statistically different p = 0.499. In multivariate regression analysis, the presence of crossing vessels was the only factor that decreased the success rate hazard ratio: 46.09, 95% confidence interval: 2.41–879.6, p = 0.011.

Conclusions

Patients who undergo RALP have a reduced hospital stay and lower use of pain medication; however, there is no difference in the success rates for OP, LP, and RALP surgeries. The presence of crossing vessels is a negative prognostic indicator for surgical outcome regardless of the surgical method.



Author: Sang Hoon Song, Chanwoo Lee, Jaeyoon Jung, Sung Jin Kim, Sungchan Park, Hyungkeun Park, Kun Suk Kim

Source: http://plos.srce.hr/



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