Comparative Study of Surgical Approaches for Renal Pelvic Stones in a Northern Rural Medical College

Introduction: Retroperitoneal pyelolithotomy (RPL) can be used as an alternative to open pyelolithotomy (OP) when other modalities of stone removal fail. This procedure even has potential to replace noninvasive techniques in selective subsets of patients. Aims and objectives: The aim of this study was to study the efficacy, safety, and outcome of retroperitoneal laparoscopic pyelolithotomy. The study compared the advantages and complications of RPL and OP. Materials and methods: This study was conducted in the Department of Surgery, Maharishi Markandeshwar Institute of Medical Science and Research, Maharishi Markandeshwar University, Ambala, from January 2012 to December 2015. A total of 280 patients of solitary renal pelvic stone were selected, out of whom 160 who underwent RPL were considered in group I and 120 patients who underwent OP were considered in group II. The patients included were of age group 12 to 80 years, with unilateral and bilateral solitary renal pelvis calculus and stone size of 10 mm to 3 cm. Patients with recurrent or residual stones after pyelolithotomy, intractable urinary tract infection, and having extrarenal pelvis and any anatomical renal abnormalities were excluded from the study. Results: In this study, mean age was 37.1 and 46.66 years in groups I and II respectively. Male to female ratio was 2.33:1. Mean operative time was 75.33 ± 16.90 and 65.83 ± 12.35 minutes respectively, in groups I and II respectively (p < 0.001). Pyelotomy closure time and Double-J (DJ) stent insertion time were 5.2 minutes (with standard deviation [SD] of 4.3) and 9.8 (with SD of 3.7) respectively, in group I as compared with 4.2 minutes (with SD of 2.7) and 6.1 (with SD of 2.9) in group II. Mean hospital stay was less in group I at 3.76 ± 0.85 days and, in group II, it was 5.36 ± 1.96 days (p < 0.001). Postoperative anesthesia requirement was 2.23 ± 0.62 days (339 ± 93 mg) and 5.36 ± 0.96 days (804 ± 144 mg) in groups I and II respectively (p < 0.001). Conclusion: The RPL is a noninvasive and cost-effective method along with minimal scar mark. It has the advantages over OP of having fewer complications, less postoperative pain, better cosmesis, and less hospital stay. OriginaL articLe 1,5,6Postgraduate Resident, 2Professor, 3Assistant Professor 4Senior Resident, 7Chief 1-6Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Haryana, India 7World Laparoscopy Hospital, Gurugram, Haryana, India Corresponding Author: Rikki Singal, Professor, Dr. Kundan Lal Hospital, Ahmedgarh, Punjab, India, e-mail: singalsurgery@ yahoo.com 10.5005/jp-journ ls-10033-1292