Transperitoneal Laparoscopic Pyeloplasty for Primary Repair of Ureteropelvic Junction Obstruction in Infants and Children: Comparison With Open Surgery Lisandro A. Piaggio, Julie Franc-Guimond,* Paul H. Noh, Mark Wehry, T. Ernesto Figueroa, Julia Barthold and Ricardo González† From the Division of Urology, Department of Surgery, A. I. duPont Hospital for Children, Wilmington, Delaware, and Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania Purpose: Pediatric laparoscopic pyeloplasty to treat ureteropelvic junction obstruction has been reported to decrease hospitalization stay and the analgesic requirement compared to open pyeloplasty. It is not clear if all age groups benefit from this procedure. We compared primary laparoscopic and open pyeloplasty in infants and children. Materials and Methods: We retrospectively reviewed the records of consecutive primary pyeloplasties at a single institution during a 4.5-year period. Demographic data, body measurements, presentation, indications for surgery, operation type, surgical time, complications, analgesia requirement, hospital stay and outcome were recorded. Results: Patients were divided in the open pyeloplasty group of 41 and the laparoscopic pyeloplasty group of 37. The groups were similar with regard to sex and laterality. There were more patients 14 months or younger in the open pyeloplasty group. Mean surgical time was longer in laparoscopic pyeloplasty but it decreased significantly after the first 15 cases (each p 0.001). Hospitalization and postoperative analgesia requirements were similar in the 2 groups. There was a higher success rate for laparoscopic pyeloplasty in patients older than 14 months (p 0.05). In the open pyeloplasty group there were more re-interventions as well as a trend toward more complications and readmissions. Conclusions: Transperitoneal laparoscopic pyeloplasty was performed safely in all pediatric age groups with minimal morbidity and excellent short-term results. In our experience laparoscopic pyeloplasty in infants and children is more difficult and time-consuming surgery than open pyeloplasty. However, it may provide a better outcome with fewer complications and better cosmesis. Prospective studies are needed to confirm these results. Key Words: ureter, kidney, obstruction, laparoscopy, ureteral obstruction S ince the first report in 1993, LP has rapidly grown in acceptance for treating adults with UPJO. 1–4 The transperineal or retroperitoneal approach with or without robotic assistance is reported to decrease hospital- ization and analgesic requirements compared to open sur- gery in children. 5,6 Studies comparing open vs transperito- neal LP are sparse and most are in the adult literature. 2,7,8 We reviewed our experience with all primary repairs of UPJO in the last 4.5 years and compared LP to OP. MATERIALS AND METHODS A retrospective chart review was performed in consecutive patients undergoing primary repair of UPJO from January 2002 to June 2006. Approval was obtained from the internal review board at our hospital. Patients with bilateral repair, solitary kidney or incomplete data were excluded. We recorded demographic data, weight, body surface area, BMI, laterality, indications for surgery, presentation, operation type, surgical time, blood loss, drain and stent use, postoperative analgesic requirements, perioperative compli- cations, length of hospitalization, success rate, the need for readmission and subsequent procedures. Patients were admitted to the hospital on the day of surgery. All patients underwent dismembered pyeloplasty with or without pelvic reduction. Most open and laparoscopic procedures were performed by a pediatric urology fellow (LP, MW or JFG) assisted by a staff member (PHN, JSB, TEF or RG). Antegrade or retrograde pyelogram was at- tempted immediately before surgery in the majority of cases. 9 Patients who underwent open surgery were approached extraperitoneally through a lateral or posterior lumbotomy incision according to surgeon preference. Repair was per- formed with 6-zero or 7-zero polydioxanone. Stenting was performed according to surgeon preference. A perinephric drain was left in all except 1 open case. LP was approached transperitoneally. Cystoscopy and retrograde pyelogram with stent placement were performed at the beginning of the procedure. In all except 2 cases 3 ports were used, including a 5 mm port for the camera and 2 working 3 or 5 mm ports according to patient size. Intra- peritoneal access was obtained using the Bailez technique. 10 The renal pelvis was exposed with medial mobilization of the colon except in 2 patients, in whom the transmesocolonic Study received hospital internal review board approval. * Current address: Division of Pediatric Urology, Centre Hospi- talier Universitaire Sainte-Justine and Université de Montreal, Montreal, Quebec, Canada. † Correspondence: A. I. duPont Hospital for Children, 1600 Rock- land Rd., Wilmington, Delaware 19899 (telephone: 302-651-5107; FAX: 302-651-6410; e-mail: ricardo_gonzalez33154@yahoo.com). 0022-5347/07/1784-1579/0 Vol. 178, 1579-1583, October 2007 THE JOURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2007 by AMERICAN UROLOGICAL ASSOCIATION DOI:10.1016/j.juro.2007.03.159 1579