Open Versus Laparoscopic Pyeloplasty - A Comparative Study

Dismembered Anderson-Hynes pyeloplasty is the Gold standard surgical treatment for uretero-pelvic junction obstruction. Revision of the renal pelvis treats the obstruction by excising the stenotic adynamic area of the uretero-pelvic junction and creating a more capacious conduit using the tissue of the remaining ureter and renal pelvis.This study focuses on the various indications, techniques, advantages, disadvantages and postoperative outcome of open pyeloplasty and laparoscopic pyeloplasty. A total of 110 children with PUJ obstruction were taken up for study of which 68 were males and 42 females. They were evaluated using renal parameters, ultrasound, Voiding cystourethrogram and DTPA. Patients were randomly taken up for open or laparoscopic pyeloplasty. They were evaluated pre operatively and post operatively regarding renal function, post op pain and hospital stay.Male to female ratio 1.6:1. Most of the patients presented in the age group of 3 to 6 years of age (50%).Majority had left sided lesion with a total of 62 (56.3%), right side 39 (35.5%) and bilateral 9 (8.2%).The most common type of presentation was mass abdomen 47 (42.8%), UTI 31 (28.2%), pain 8 (7.3%), antenatally 24 (21.7%).Among the 110 patients the renogram showed improved differential renal function in 96 patients of which 52 patients belonged to the Laparoscopic group and 44 patients belonged to the open group. Laparoscopic pyeloplasty is a technically sound operation which uses well established principles. The advantages of open pyeloplasty are lesser operating times.The only disadvantage of Laparoscopic pyeloplasty is longer operative time and requires significant skill of intracorporeal knotting. In our series, none of the cases had detoriation in function in laparoscopic group with no redo cases .This procedure has a minimal level of morbidity, shorter hospital stay, better cosmetics compared to open approach and has emerged as the standard of care for all irrespective of age.