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ORIGINAL ARTICLE
Comparison of laparoscopic pyeloplasty and open pyeloplasty for the treatment
of primary uretero pelvic junction obstruction
1
Ak. Kaku Singh, 2 N.P.Gupta,
Abstract
Objectives: To compare the complications ,
hospital stay , and functional results of
laparoscopic and open pyeloplasty for primary
uretero pelvic junction (UPJ) obstruction.
Methods: From July 2004 to Dec. 2006, 56
consecutive non randomized patients of
primary UPJ obstruction who underwent open
and laparoscopic pyeloplasty in All India
Institute of Medical Sciences were included
in the study.There were 31 cases of
laparoscopic pyeloplasty and 25 cases of
open pyeloplasty .The decision between the
two techniques depended on patient‘s
preference and surgeon‘s experience .The
preoperative evaluation included history of
clinical symptoms, ultrasound, X-ray IVP and
renal dynamic scan . The patients were
followed up at 3 months and 1 year after the
surgery by evaluation of clinical symptom and
renal dynamic scan. Success was
considered if there was improvement of
symptom and absence of an obstructive
pattern during the washout phase of a renal
scan. Result: The mean operating time was
less in the open than in the laparoscopy group
( 98 mins and 145 mins respectively). The
mean blood loss was 85ml in the laparoscopy
and 101 ml in the open pyeloplasty group. The
mean analgesic requirement was less in the
1. Associate Professor, Department of Urology,
RIMS, Imphal, 2. Ex. Professor and Head
Department of Urology AIIMS , New Delhi
Address for correspondence
Dr.Ak.Kaku Singh, Associate Professor,
Department of Urology RIMS , Imphal
Pin : 795004 e-mail : kakuakoijam@yahoo.com
laparoscopy group than in the open group
(75mg vs 127 mg of pethidine). No
intraoperative complications occurred in either
group. Post operative complications occurred
in 2/31 cases in laparoscopic group and none
in the open group.The mean hospital stay was
5.8 days for laparoscopic pyeloplasty and 6.7
days for open pyeloplasty. Of the 27 cases in
the laparoscopy group, 25 cases were free of
symptoms and all the 22 patients in the open
group were free of symptoms. Renal scan
shows good clearance in 23 cases, slow
clearance in 3 cases and obstructed drainage
in 1 in the laparoscopy group, and good
clearance in19 cases and slow clearance in
3 cases in the open group. At 1 year follow
up, 14 cases were available in group I, all were
free of symptoms and 12 showed good
clearance and 2 showed slow clearance .And
in group II, 10 cases were available for follow
up , all were free of symptoms and 8 cases
showed good clearance and 2 cases showed
slow clearance on diuretic renogram.
Conclusion: Laparoscopic pyeloplasty is
associated with decreased hospital stay and
early recovery from pain but takes longer
operating time and has comparable functional
results as open pyeloplasty.
Key words: Laparoscopic pyeloplasty, open
pyeloplasty.
Introduction: Open Anderson Hyne’s
dismembered pyeloplasty is the gold standard
for the treatment of UPJ obstruction with the
highest long term success rate with which
other techniques should be compared 1.
Laparoscopic pyeloplasty which was first
4 JMS * JMS Vol 25 * Vol * No. 25 3 * No. * September, 1 * June, 2010 2011