Comparison of clinical efficacy of dismembered pyeloplasty via different surgical approaches in the treatment of UPJO induced hydronephrosis in children

Abstract:

Objective To compare the clinical efficacy of dismembered pyeloplasty via different surgical approaches in the treatment of ureteropelvic junction obstruction（UPJO） induced hydronephrosis in children.Methods The clinical data of 90 children with hydronephrosis caused by UPJO admitted to Anhui Children’s Hospital from January 2019 to October 2021 were retrospectively selected. According to the approach of the dismembered pyeloplasty，they were divided into laparoscopic group（n=49） and conventional group（n=41）. The laparoscopic children were treated with three-hole laparoscopic dismembered pyeloplasty， and the conventional group were treated with the dismembered pyeloplasty through the transverse incision of the waist and abdomen. The anastomotic time，the amount of bleeding，the length of incision and the amount of paracetamol after operation were compared between the two groups. Comparison of anterior and posterior renal pelvis diameter and renal cortical thickness before and after surgery in the two groups was also made. The average hospitalization time， average feeding time and hospitalization expenses after operation were compared between the two groups. The incidence of complications such as incision infection，urinary exostosis and fever were compared between the two groups.Results Children in the laparoscopic group had shorter intraoperative anastomosis time and incision lengths，and lower intraoperative bleeding and postoperative acetaminophen doses than children in the conventional group（P<0.05）. After surgery， children in the laparoscopic group had lower anterior and posterior pelvic diameters and higher renal cortical thickness compared to the conventional group（P<0.05）. Children in the laparoscopic group had a shorter average postoperative hospital stay，a shorter average postoperative feeding time and lower postoperative hospital costs than children in the conventional group（P<0.05）. The complication incidence of children in the laparoscopic group was 12.24%（6/49） lower than that of children in the conventional group，which was 36.58%（15/41）（P<0.05）.Conclusion The results of dissecting pyeloplasty for hydronephrosis due to UPJO in the pediatric population are significantly better with a three-hole laparoscopic procedure than with a conventional transverse lumbar abdominal incision.