A Clinical Study Of Transperitoneal And Retroperitoneal Laparoscopic Pyeoplasty

Objective:To evaluate advantages,disadvantages and clinical value on both approaches by investigating the clinical indicator of both approaches of laparoscopic pyeloplasty, transperitoneal vs retroperitoneal.Methods:Retrospectively reviewed clinical data49cases of laparoscopic pyeloplasty from September2010to Octorber2012in xiangya hospital.21cases undergoing transperitoneal approache and28cases undergoing retroperitoneal approach.The differences between the two groups were compared and statistically analyzed in regard to the sex,the age,the side of operation,the body mass index,the main diagnosis,the clinical manifestation,the maging findings, the operative time,the suturing time,the estimated blood loss,the length of incision,the perioperative complications, time to anal exsufflation, time of postoperative drainage,the visual analog pain scale, time to ambulation,analgesic requirement, postoperative hospital stay, time of D-J stent removement,the situation of B ultrasound and IVU.Result:All operations of the two groups were performed successfully. None of two Group experienced conversion to open surgery. In transperitoneal group mean operating time was157.62±38.162min, the mean suturing time72.71±13.704min,intraoperative mean estimated blood loss was38.52±17.206ml, the length of incision was2.62±0.258cm, time to anal exsufflation was2.90±0.889d,2patients used analgesia, the visual analog pain scale was3.12±0.794,mean time of postoperative drainage was4.38±1.431d,mean time to ambulation was2.43±1.075d, mean postoperative hospital stay was6.47±1.536d.2patients with subcutaneous emphysema,2patients with hypercapnia,2patients with urine leakage,1patient with secondary peritonitis.mean time of D-J stent removement was10.33±1.683w,the hydronephrosis improvement rate was95.2%. In retroperitoneal group mean operating time was149.54±31.257min, the mean suturing time was83.32±13.958min,intraoperative mean estimated blood loss was34.54±14.487ml, the length of incision was3.58±0.246cm, time to anal exsufflation was2.04±0.881d,4patients used analgesia, the visual analog pain scale was3.38±0.648,mean time of postoperative drainage was3.75±1.110d,mean time to ambulation was1.89±0.916d, mean postoperative hospital stay was6.17±1.020d,10patients with subcutaneous emphysema,3patients with hypercapnia,l patients with urine leakage,.mean time of D-J stent removement was9.64±1.283w,the hydronephrosis improvement rate was92.9%. The patients were followed up for6-12months.Comparing with these two groups,there were no significant differences between the sex,the age,the side of operation,the body mass index,the clinical manifestation,the situation of hydroneprosis. No significant differences between the operative time, the estimated blood loss, time of postoperative drainage, time to ambulation, postoperative hospital stay, analgesic requirement,the visual analog pain scale,the total number of complication, time of D-J stent removement, the hydronephrosis improvement rate;There were significant differences between the2groups in terms of suturing time,time to anal exsufflation,length of incision number of subcutaneous emphysema (P<0.05).Conclusions:1Transperitoneal and retroperitoneal laparoscopic pyeoplasty were safe and feasible.2The gastroenteric function of retroperitoneal laparoscopic pyeloplasty recovers more quickly than transperitoneal approach.3The transperitoneal approach was associated with shorter suturing time than retroperitoneal approach.4The transperitoneal laparoscopic pyeloplasty presents a better cosmetic outcome.