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Open Pyeloplasty in Infants under 1 Year-Proven or Meaningless?

ABSTRACT: The use of minimally invasive surgery (MIS) to treat ureteropelvic junction obstruction (UPJO) in children has significantly increased. Nowadays, open pyeloplasty (OP) seems to lose importance. The aim of this study is to evaluate the safety and efficacy of OP in infants < 1 year. Medical records of patients < 1 year with UPJO who had undergone retroperitoneal OP (January 2008-February 2022) at our institution were retrospectively analyzed. Included patients were operated on according to a modified Anderson-Hynes technique. All clinical, operative, and postoperative (1 month-5 years' follow-up) data were collected. Additionally, a nonvalidated questionnaire was sent to the patients/parents. A total of 162 infants (124 boys) met the inclusion criteria. The median age at surgery was 3 months (range: 0-11 months). The median operation time was 106 min (range: 63-198 min). None of the patients had severe surgical complication (Clavien-Dindo > 3). The nonvalidated questionnaire showed a high impact of quality of life. Follow-up was in median 30.5 months (0-162 months). OP is still a reliable procedure with good long-term results especially in infants < 1 year of age, which can be performed in a variety of centers.

SUBMITTER: Vauth F

PROVIDER: S-EPMC9955854 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Open Pyeloplasty in Infants under 1 Year-Proven or Meaningless?

Vauth Franziska F Zöhrer Pirmin P Girtner Florian F Rösch Wolfgang H WH Hofmann Aybike A

Children (Basel, Switzerland) 20230131 2

The use of minimally invasive surgery (MIS) to treat ureteropelvic junction obstruction (UPJO) in children has significantly increased. Nowadays, open pyeloplasty (OP) seems to lose importance. The aim of this study is to evaluate the safety and efficacy of OP in infants < 1 year. Medical records of patients < 1 year with UPJO who had undergone retroperitoneal OP (January 2008-February 2022) at our institution were retrospectively analyzed. Included patients were operated on according to a modif ...[more]

PMID: 36832385

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Project description:BackgroundThe treatment for the renal ureteropelvic junction obstruction (UPJO) is mainly dominated by laparoscopic minimally invasive techniques. Open surgery is used less frequently. However, in regions where endoscopic techniques are not yet well-developed or in very young infants, open pyeloplasty (OP) still plays a significant role. This study aims to investigate the clinical efficacy and safety of transumbilical incision open pyeloplasty (TUOP) in infants by comparing it with laparoscopic pyeloplasty (LP).MethodsA retrospective analysis involving 40 infants (≤6 months) who underwent pyeloplasty at Department of Urology, Anhui Provincial Children's Hospital was conducted between April 2021 and April 2024. Eighteen infants were in the TUOP group, and 22 were in the LP group. After operation, the mean follow-up period of all infants was 18 (range, 6-28) months. The two groups were compared in terms of age, weight, operation time, duration of the indwelling catheter and peritoneal drainage, postoperative incision satisfaction, hospitalization costs and degree of recovery from postoperative hydronephrosis.ResultsThere were no significant differences between the two groups in terms of the duration of abdominal drainage tubes used (P=0.67) or the duration of catheter retention (P=0.56). There were significant statistical differences between the two groups in terms of age (P=0.003), weight (P=0.02), operation time (P<0.001), postoperative incision satisfaction (P=0.03), and hospitalization costs (P=0.04). Compared with the preoperative results, the postoperative Society of Fetal Urology (SFU) grades were significantly improved in both groups.ConclusionsCompared with the LP approach, TUOP treatment for infants with giant hydronephrosis is safe and effective, it has the advantages of a shorter surgical time, lower hospitalization costs, and involves an aesthetic and concealed incision. It is more worthy of promotion and application in younger infants or economically disadvantaged areas where endoscopic techniques are underdeveloped.

Project description:IntroductionPatient age and hospital volume have been shown to affect perioperative outcomes after pediatric pyeloplasty. However, there are few multicenter studies that focus on outcomes at teaching hospitals, where many of the operations are performed.ObjectiveThe goal was to determine if surgical approach, age, case volume, or other factors influence perioperative outcomes in a large contemporary cohort.Study designUsing the clinical database/resource manager (CDB/RM) of the University Health-System Consortium (UHC), children who underwent open, laparoscopic, or robotic pyeloplasty from 2011 to 2014 were identified at 102 academic institutions. Surgery type, age, race, gender, insurance type, geographic region, comorbidities, surgeon volume, and hospital volume were measured. Multivariable mixed-effects logistic regression analysis was used to analyze independent variables associated with complication rates, length of stay (LOS), readmission rates, and ICU admission.ResultsA total of 2219 patients were identified. Complication rates were 2.1%, 2.2%, and 3% after open, laparoscopic, and robotic pyeloplasty, respectively. Approximately 12% of patients had underlying comorbidities. Comorbidities were associated with 3.1 times increased odds for complication (p = 0.001) and a 35% longer length of stay (p < 0.001). Age, gender, insurance type, and hospital volume had no effect on complication rates. A trend was seen towards a lower rate of complications with higher surgeon volume (p = 0.08). The mean LOS was 2.0 days in the open pyeloplasty group, 2.4 days in the laparoscopic group and 1.8 days in the robotic group. Patients who underwent robotic surgery had an estimated LOS 11% shorter than those after open surgery (p = 0.03) (Table). Patients aged 5 years and under who had robotic surgery had an estimated LOS 14% shorter than those after open surgery (p = 0.06). ICU admission and hospital readmission were not associated with any variables.DiscussionThe study is limited by the accuracy of the data submitted by the hospitals and is subject to coding error. Complication rates remain low in all three approaches, validating their safety. Patients, including younger patients, had shorter lengths of stay after robotic surgery. The statistically significant differences between approaches were small so clinically there may not be a difference.ConclusionsThis large multicenter analysis demonstrates that patient comorbidity had the greatest impact upon complication rates and length of stay. Previous work showed that the benefits of laparoscopy were limited to older children. However, this large multicenter study suggests that these benefits now extend to young children with the application of robotics.

Project description:IntroductionWe compare open pyeloplasty (OP) versus laparoscopic pyeloplasty (LP) in children in a multicenter, prospective, case-control study.Materials and methodsFrom May 2007 to March 2009, a program was established at Hospital Garrahan, the reference center, to perform LP with a mentoring surgeon that would attend the institution once a month. Every new case of ureteropelvic junction obstruction (UPJO) diagnosed in the reference institution was offered to participate in the study. If the patient was enrolled, it was scheduled for LP. The following patient diagnosed with UPJO was operated on with open technique and served as a case-control. In three other facilities, patients were only offered LP and had a matched control open case at the reference institution. The first end point of the study was patient recovery: analgesia requirement and length of hospitalization (LOH). The second end point of the study was resolution of UPJO in long-term follow-up for the two techniques. Demographic data, surgical time, perioperative complications, analgesia requirement, analgesia score during hospitalization, LOH, and outcome were recorded. Both groups received the same postoperative indications for pain control. Parents were asked to assess pain in their children every 4 h postoperatively and to complete a pain scale chart to which the nurses were blinded.ResultsFifteen OP and 15 LP were compared. Groups were similar with regard to sex, age, weight, and laterality. Mean surgical time was longer in LP than in OP group (mean 188 versus 65 min) (p < 0.01). Hospitalization was shorter for LP group with a mean of 1.9 versus 2.5 days for OP group (p < 0.05). Postoperative analgesia requirement was significantly higher in the OP group with a mean use of morphine of 1.7 versus 0.06 mg/kg in the LP group (p < 0.05). Pain scores were similar in both the groups. At a mean follow-up of 58 months there were no failures.ConclusionIn this prospective comparative cohort, LP was a longer procedure than OP. Both procedures had the same efficacy and complication rates, but patients undergoing LP needed fewer narcotics for pain control and had a shorter hospitalization.

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Open Pyeloplasty in Infants under 1 Year-Proven or Meaningless?

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Open Pyeloplasty in Infants under 1 Year-Proven or Meaningless?

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