Objectives: To assess if experience based approaching of laparoscopic pyeloplasty (LP) will balance the reported significant higher conversion rate and longer operative time in the retroperitoneal compared to the transperitoneal approach.
Patients and method: Between November 2012 and November 2014, fifty patients diagnosed of UPJO were prospectively recruited for Anderson-Hynes laparoscopic pyeloplasty either transperitoneally (TLP) by transperitoneal laparoscopist or retroperitoneally (RLP) by retroperitoneal laparoscopist. All patients were assessed preoperatively by excretory urography (IVU), diuretic isotope renography and computed tomography angiography, when indicated. Postoperatively, patients were followed-up at 3 months, and every 6 months afterwards. Follow-up measures included
clinical examination, IVU and diuretic renography. Perioperative data including the conversion rate and operative time, functional outcome, and postoperative complications were compared between both groups.
Results: Twenty five patients were included in each group, with a mean follow-up of 18.44 ±3.48 and 20.25±3.53 months in TLP and RLP, respectively. Preoperative data were comparable between both groups. All procedures were successfully completed with laparoscopy except for 2 (8%) and 3 (12%) patients (p=0.9) which were converted to open surgery in TLP and RLP, respectively. Mean operative time was significantly shorter in TLP (191±53.8 vs. 223±55.4 min, p=0.04). Both were comparable in terms of hospital stay (6.24±2.8 vs. 6.12±2.6 days; p=0.9) and success rate (92% vs. 88%; p=0.7). Postoperative complications were detected in 6 (24%) and 5 (20%) patients (p=0.9) in TLP and RLP.
Conclusion: The experience- based approach of laparoscopic pyeloplasty has neutralized the higher conversion rate. However, retroperitoneal approach was still associated with longer operative time.