A Comparative Study Of Transperitoneal Laparoscopic Dismembered Pyeloplasty And Open Retroperitoneal Surgery For Ureteropelvic Junction Obstruction

Background and purpose:Laparoscopy has been used only more than ten years history in urologic surgery. Laparoscopy has developed rapidly, and has been shown to be useful in many different applications of urologic surgery, from laparoscopic untoofing of renal cyst and ligation of spermatic vein to pyeloplasty. As compared with open operation, laparoscopy has the advantages of minimal invasion, less suffering,quicker recovery ,less complication and same long-term ourcome,In the past three years, we performed less than forty transperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction (UPJO). Our researches focus on evaluating the clinical efficacy of transperitoneal laparoscopic dismembered pyeloplasty in comparision to the open surgery during the corresponding time period.Methods:1. Including and excluding standard: (1) Including standardChoose the cases of UPJO including congenital ureteropelvic junction development malformation , secondum polyp after ureteropelvic junction stone and crossingvessels.(2) Excluding standardWe rule out those cases operated concomitant with other surgery (such as cholecystectomy, gynecological surgery, et al) in the case data was interfered.2. Assemble the data:(1) Between October 2001 and October 2004 data were respectively obtained on our 38 consecutive cases of UP JO patients who were operated by laparoscopic dismembered pyeloplasty. We gathered the detailed clinical data of these patients, including age, total operation time, blood loss, time to oral liquids, time of intravenous antibiotic, time of drainage, postoperation analgesia, time of postoperative hospital stay, time of resume work ,postoperative complications.(2) Between October 2001 and October 2004 data were respectively obtained on our 40 consecutive cases of UP JO patients who were operated by open dismembered pyeloplasty. We gathered the detailed clinical data of these patients, including age, total operation time, blood loss, time to oral liquids, time of intravenous antibiotic, time of drainage, postoperation analgesia, time of postoperative hospital stay, time of resume work ,postoperative complications.3. Data analyzing:(1) We evaLUUAted the role of the laparoscopic dismembered pyeloplasty in contrast to the open surgery by analyzing the data of the age, total operation time, blood loss, time to oral liquids, time of intravenous antibiotic, time of drainage, time of postoperative hospital stay, postoperation analgesia,time of resume work, postoperative complications.(2) All the data were analyzed by SPSS 11.0 for windows. We chose different statistical method depended on the different data information.Result:(1) Between October 2001 and October 2004 data, we treated 38 cases by laparoscopic dismembered pyeloplasty, all operation were successful and noconversions to open operation. Mean operative time was 137.13 ± 30.51minutes (70-210min), mean estimated blood loss was 143.8.1+45.23 (15-200ml) , postoperation analgesia time was 0.8±0.2d(0-2d), time of postoperative hospital stay was 7.15 + 1.28d(4-12d), time of resume work was 24.3 ±5.6d(14-42d). no paitient in this series reguired transfusion.(2) Between October 2001 and October 2004 data, we treated 40 cases by open dismembered pyeloplasty, Mean operative time was 143.82±45.24minutes (65-240min), mean estimated blood loss was 245.35 ± 80.96ml (100-500ml), postoperation analgesia time was 1.5±0.5d (l-5d), time of postoperative hospital stay was 10.34±2.66d(5-21d), time of resume work was 43.2 + 11.4d(30-90d).(3) Comparing the results of laparoscopic dismembered pyeloplasty with open operation, the age, the mean operative time, and postoperative complications were no significant differences, but the mean volume of blood loss, time to oral liquids, time of intravenous antibiotic, time of drainage, time of postoperative hospital stay were statistically significant different, the laparoscopic approach was more minimally invasive than the open approach in management the UP JOConclusion:As compared with open retroperitoneal dismembered pyeloplasty for UP JO, transperitoneal laparoscopic dismembered pyelopasty for UPJO has the advantages of minimal invasion, less suffering,quicker recovery ,less complication and same long-term ourcome, which would be an alternative to open surgery and the "gold standard" for treatment of UPJO .