Comparison Of Retroperitoneal Laparoscopic And Open Pyeloplasty For Ureteropelvic Junction Obstruction

Objective:Compare the surgery and clinical efficacy of retroperitoneal laparoscopic pyeloplasty with open retroperitoneal surgery for UPJO in order to assess the clinical value of laparoscopic surgery.Methods:Retroperitoneal dismembered pyeloplasty:The patient was placed in a lateral position under general anesthesia. Three trocars were made over the midaxillary line above the iliac crest,over the preaxillary and postaxillary line beneath the 12th rib.A fourth port was inserted if necessary over the predaxillary line above the iliac crest. Gerota's fascia was opened before the psoas major.The lower pole of the kidney, the dilated renal pelvis and the upper ureter were then mobilized. The PUJ was identified before it was dismembered.The pelvi-ureteric anastomosis was completed with absorbable sutures and a D-J stent was inserted. Open dismembered pyeloplasty: The patient was placed in a lateral position under general anesthesia or epidural anesthesia. Subcostal incision was made. The lower pole of the kidney, the dilated renal pelvis and the upper ureter were mobilized before the psoas major. Cut the pelvis 2cm away from the parenchyma and the PUJ was dismembered. The pelvi-ureteric anastomosis was completed with absorbable sutures and a D-J stent was inserted.Results : Intraoperative blood loss[35(20,70)]ml,postoperative analgesic requirements(0.7±0.3)d,postoperative length of hospital stay(8.5±6.1)d of laparoscopic surgery are better than those of open surgery[110(60,175)]ml,(1.3±0.5)d,(15.5±10.8)d,(t=7.502,P=0.000;t=-5.842,P=0.000;t=-3.193,P=0.002),while operative time(156.9±69.2)min is longer than those of open surgery(111.9±78.1)min(t=2.514,P=0.014).The incidence of postoperative complications and improvement of hydronephrosis of two methods are equivalent(t=0.000,P=1.000;χ2=5.192,P=0.182).Conclusions : Compared with open retroperitoneal dismembered pyeloplasty, retroperitoneal laparoscopic pyeloplasty for UPJO has the advantage of minimal blood loss and quicker recovery and compareable long-term outcome.