INTRODUCTION AND OBJECTIVES: There are few retrospective studies comparing open pyeloplasty (OP) versus laparoscopic pyeloplasty (LP). These reports favor LP in decreasing length of hospitalization and analgesic requirement. We compare LP versus OP for primary repair of ureteropelvic junction obstruction (UPJO) in children in a multicenter prospective, randomized, case control study.

METHODS: IRB was obtained from all participating institutions. From May 2007 to March 2009, in a high volume pediatric hospital LP was randomly offered in the clinic as the patients were diagnosed with UPJO. If accepted to participate in the study they were scheduled for LP once a month when a teaching surgeon performed the case. The following patient diagnosed with UPJO was operated with OP and used as case control. In three other community hospitals patients were only offered LP. Demographic data, surgical time, perioperative complications, analgesia requirement, analgesia score during hospitalization, length of hospitalization and outcome were recorded. Exclusion criteria were solitary kidney, associated kidney stones or comorbidities. LP was performed transperitoneally with three ports. Kidney was access through a flank incision in OP. In all cases a double J ureteral stent, Foley catheter and perinephric drain were placed during the procedure and a dismembered pyeloplasty performed with a 5 or 6 monofilament running suture. Pain control was performed by trained pediatric nurses using international standards with NSAID and narcotics. Parents were asked to assessed pain in their children every 4 hours postoperatively and to complete a pain scale chart to which the nurses were blinded.

RESULTS: There were 35 patients, 15 OP, 20 LP (15 included in the study). Groups were similar with regard to sex, age, weight and laterality. Mean surgical time was longer in LP than OP group (mean 188 vs 65 minutes) (p <. 01). There was a trend towards shorter hospitalization for LP groups (mean 1.9 vs 2.5 days) (> 05). Postoperative analgesia requirement was significantly higher in the OP group with a mean use of morphine of 1,7 mg/kg vs 0.06 mg/kg in the LP group (p <. 05). Pain scores were similar in both groups. There were 4 complications in the LP and 3 in OP group. There was no need for transfusions in any group. At a mean follow up of 16 months there were no failures.

CONCLUSIONS: In this prospective comparative cohort, LP was a longer procedure than OP. Both procedures had the same efficacy and complication rate, but patients undergoing LP needed fewer narcotics for pain control and had a trend towards shorter hospitalization.