Retroperitoneal Laparoscopic Versus Open Anderson-Hynes Pyeloplasty: Initial Experience In 6 Cases

Ureteropelvic junction obstruction leads to progressive dilatation of the renal collecting system, and can result in pain and progressive deterioration of renal function. The gold standard therapy for repair of ureteropelvic junction obstruction has been open pyeloplasty with success rates greater than 90%. Endoscopic incision either in an antegrade or retrograde fashion provides an attractive minimally invasive alternative. However, these procedures have lower success rates of 70% to 89% evin in highly select patients. Patients at high risk for failure include those with a large redundant renal pelvis, crossing vessels or poor renal function (less than 20%). In such cases reconstructive pyeloplasty may provide an advantage. Since 1993, laparoscopic surgeons have continued to use the Anderson-Hynes pyeloplasty, the Foley Y-V advancement, and Fenger-plasty. Preliminary reports havedemonstrated the feasibility of laparoscopic procedures in experienced hands, with a lower morbidity and shorter convalescence, and operative success rates comparable with those of open techniques. In this study, we compared the outcome assessment of the pyeloplasty between retroperitoneal laparoscopic and open Anderson-Hynes.Objective: To assess the feasibility and results of retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction.Methods: From June 2001 to February 2002, 16 consecutive nonrandomized patients underwent 6 patients underwent retroperitoneal laparoscopic (laparoscopy group) and 10 patients underwent open Anderson-Hynes pyeloplasty (open surgery group). The decision between the two techniques depended on the patient's anesthetic ability to tolerate laparoscopic pyeloplasty, previous ureteropelvic junction surgery, and the surgeon's laparoscopic experience. Subjective outcomes as to postoperative pain and convalescence and objective findings on intravenous urography were assessed at 3 months postoperatively in both groups.Results: All procedures were successfully completed. The mean operating time 279 minutes for laparoscopic pyeloplasty was much more longer than the time 121 minutes for open (p<0.001). The mean hospital stay time, operating bleeding volume, postoperative complication and hospital cost were same in the two groups. No severe postoperative complications were found. 3 months after the procedure the pain-free rates in flank pain were same between the two groups, but the open surgery group had much pain andprolonged convalescence from a flank incision. The B type ultrasound and intravenous urography 3 months after the procedure showed good results.Conclusions: Laparoscopic pyeloplasty is a minimally invasive technique that provides durable clinical and radiographic results in a similar fashion as open pyeloplasty.