Abstract
Introduction
The aim of the study was to compare 3 mm mini-laparoscopy (mini LP), standard 5 mm laparoscopy (LP) and open surgery for pediatric pyeloplasty in a single center.
Methods
Patients who underwent pyeloplasty from 1997 to 2017 at Hospital Sant Joan de Déu were prospectively collected. Demographic data, clinical, surgical and radiological variables were assessed. A multivariate logistic regression analysis was performed in order to identify risks for surgical complications, urinary leak and need for redo-surgery.
Results
340 pyeloplasties were performed in this period: 197 open, 30 LP and 113 mini LP. Independent risk factors for surgical complications in a multivariate logistic regression model were: LP (vs mini LP, OR = 3.95; 95% CI: 1.13–13.8), higher differential renal function (each point more increases the risk 6%; 95% CI: 1–11%), older children (every year increases the risk 1.11 times; 95% CI: 1.002–1.225). Open surgery, pelvis diameter or the use of different stents were not risk factors. This model had an 80% PPV and a 92% NPV. LP (OR = 4.65; 95% CI: 1.08–19.96) and longer surgical time (OR = 1.014; 95% CI: 1.003–1.025) were independent risk factors for urinary leak. Higher pelvis diameter (OR = 0.93; 95% CI: 0.87–0.99) and the use of external stents were independent protective risk factors for urinary leak (OR = 0.09; 95% CI: 0.01–0.72). We have not found independent risk factors for redo-surgery in a multivariate logistic regression model.
Conclusion
mini LP can be safely and effectively used to perform pyeloplasty in pediatric patients of all ages.
Acknowledgements
The authors thank Michella McMullan for her linguistic revision.
Disclosure statement
No potential conflict of interest was reported by the author(s).