Comparison of the laparoscopic transperitoneal pyeloplasty to the extraperitoneal open and retroperitoneoscopic approaches in children: technical aspects and early outcomes from a developing practice

Abstract Introduction Retroperitoneal pyeloplasty ( RP ) was thought to be associated with fewer possible complications than the transperitoneal approach ( TP ); however, TP offers larger working space and an easier anastomosis, anterior to crossing lower pole vessels, when present. In TP , the peritoneum can be easily reconstructed back, and cosmesis is nearly similar. We reviewed our experience with RP and TP in comparison with the classic open extra/retroperitoneal approach ( OP ). Material and methods Data from 156 cases who had pyeloplasty were reviewed: TP : 40 consecutive cases (27 over 5 years old, 13 under 5 years old and 3 under 1 year old; youngest - 5 months old), including 3 redo/revision cases; RP : 56 consecutive primary cases, all over 5 years of age; and OP : 60 primary cases (41 over 5 years old, 19 under 5 years old, and 9 under 1 year old; youngest - 3 months old). Operation time, conversion rate, and complications were all compared. Unpaired t -test and chi-square test were used, and p < 0.05 was considered significant. Results There were no intraperitoneal surgical complications such as organ injury or bowel adhesions with TP . TP was operatively shorter than RP (230.4 ± 29 vs. 249.8 ± 46 min, p = 0.0036). The conversion rate was lower in TP than in RP [1/40 (2.5%) vs. 3/56 (5%), p = 0.380]. There was neither a difference in hospital stays (both 3 days) nor a statistically significant difference in postoperative complications requiring intervention as JJ stenting, balloon dilatation, and redo/revision pyeloplasty [ TP : 4/40 (10%) vs. RP : 4/56 (7%), p = 0.6003, and vs. OP : 5/60 (8%), p = 0.7308)]. Conclusion TP is safe, effective, and relatively shorter than RP and suitable for much younger patients and redo/revision pyeloplasties. Transperitoneal pyeloplasty remains a viable and justifiable option for developing and aspiring paediatric surgeons and urologists.