Comparison of the laparoscopic transperitoneal pyeloplasty to the extraperitoneal open and retroperitoneoscopic approaches in children: technical aspects and early outcomes from a developing practice
Abstract Introduction Retroperitoneal pyeloplasty (RP) was thought to be associated with fewer possible complications than the transperitoneal approach (TP); however, TP offers larger working space and an easier anastomosis, anterior to crossing lower pole vessels, when present. In TP, the peritoneu...
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| Language: | English |
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SpringerOpen
2025-06-01
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| Series: | Egyptian Pediatric Association Gazette |
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| Online Access: | https://doi.org/10.1186/s43054-025-00360-z |
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| author | Mahmoud Marei Marei Supul Hennayake Tamás Cserni |
| author_facet | Mahmoud Marei Marei Supul Hennayake Tamás Cserni |
| author_sort | Mahmoud Marei Marei |
| collection | DOAJ |
| description | Abstract Introduction Retroperitoneal pyeloplasty (RP) was thought to be associated with fewer possible complications than the transperitoneal approach (TP); however, TP offers larger working space and an easier anastomosis, anterior to crossing lower pole vessels, when present. In TP, the peritoneum can be easily reconstructed back, and cosmesis is nearly similar. We reviewed our experience with RP and TP in comparison with the classic open extra/retroperitoneal approach (OP). Material and methods Data from 156 cases who had pyeloplasty were reviewed: TP: 40 consecutive cases (27 over 5 years old, 13 under 5 years old and 3 under 1 year old; youngest - 5 months old), including 3 redo/revision cases; RP: 56 consecutive primary cases, all over 5 years of age; and OP: 60 primary cases (41 over 5 years old, 19 under 5 years old, and 9 under 1 year old; youngest - 3 months old). Operation time, conversion rate, and complications were all compared. Unpaired t-test and chi-square test were used, and p < 0.05 was considered significant. Results There were no intraperitoneal surgical complications such as organ injury or bowel adhesions with TP. TP was operatively shorter than RP (230.4 ± 29 vs. 249.8 ± 46 min, p = 0.0036). The conversion rate was lower in TP than in RP [1/40 (2.5%) vs. 3/56 (5%), p = 0.380]. There was neither a difference in hospital stays (both 3 days) nor a statistically significant difference in postoperative complications requiring intervention as JJ stenting, balloon dilatation, and redo/revision pyeloplasty [TP: 4/40 (10%) vs. RP: 4/56 (7%), p = 0.6003, and vs. OP: 5/60 (8%), p = 0.7308)]. Conclusion TP is safe, effective, and relatively shorter than RP and suitable for much younger patients and redo/revision pyeloplasties. Transperitoneal pyeloplasty remains a viable and justifiable option for developing and aspiring paediatric surgeons and urologists. |
| format | Article |
| id | doaj-art-77cd5e196ba54079aaf7c247c84ec14f |
| institution | OA Journals |
| issn | 2090-9942 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Egyptian Pediatric Association Gazette |
| spelling | doaj-art-77cd5e196ba54079aaf7c247c84ec14f2025-08-20T02:06:20ZengSpringerOpenEgyptian Pediatric Association Gazette2090-99422025-06-017311810.1186/s43054-025-00360-zComparison of the laparoscopic transperitoneal pyeloplasty to the extraperitoneal open and retroperitoneoscopic approaches in children: technical aspects and early outcomes from a developing practiceMahmoud Marei Marei0Supul Hennayake1Tamás Cserni2Department of Paediatric Urology, The Royal Manchester Children’s Hospital (RMCH), Manchester University NHS Foundation Trust (MFT)Department of Paediatric Urology, The Royal Manchester Children’s Hospital (RMCH), Manchester University NHS Foundation Trust (MFT)Department of Paediatric Urology, The Royal Manchester Children’s Hospital (RMCH), Manchester University NHS Foundation Trust (MFT)Abstract Introduction Retroperitoneal pyeloplasty (RP) was thought to be associated with fewer possible complications than the transperitoneal approach (TP); however, TP offers larger working space and an easier anastomosis, anterior to crossing lower pole vessels, when present. In TP, the peritoneum can be easily reconstructed back, and cosmesis is nearly similar. We reviewed our experience with RP and TP in comparison with the classic open extra/retroperitoneal approach (OP). Material and methods Data from 156 cases who had pyeloplasty were reviewed: TP: 40 consecutive cases (27 over 5 years old, 13 under 5 years old and 3 under 1 year old; youngest - 5 months old), including 3 redo/revision cases; RP: 56 consecutive primary cases, all over 5 years of age; and OP: 60 primary cases (41 over 5 years old, 19 under 5 years old, and 9 under 1 year old; youngest - 3 months old). Operation time, conversion rate, and complications were all compared. Unpaired t-test and chi-square test were used, and p < 0.05 was considered significant. Results There were no intraperitoneal surgical complications such as organ injury or bowel adhesions with TP. TP was operatively shorter than RP (230.4 ± 29 vs. 249.8 ± 46 min, p = 0.0036). The conversion rate was lower in TP than in RP [1/40 (2.5%) vs. 3/56 (5%), p = 0.380]. There was neither a difference in hospital stays (both 3 days) nor a statistically significant difference in postoperative complications requiring intervention as JJ stenting, balloon dilatation, and redo/revision pyeloplasty [TP: 4/40 (10%) vs. RP: 4/56 (7%), p = 0.6003, and vs. OP: 5/60 (8%), p = 0.7308)]. Conclusion TP is safe, effective, and relatively shorter than RP and suitable for much younger patients and redo/revision pyeloplasties. Transperitoneal pyeloplasty remains a viable and justifiable option for developing and aspiring paediatric surgeons and urologists.https://doi.org/10.1186/s43054-025-00360-zPelviureteric junction obstructionUreteropelvic junction obstructionHydronephrosisPyeloplastyPaediatric laparoscopyLaparoscopic pyeloplasty |
| spellingShingle | Mahmoud Marei Marei Supul Hennayake Tamás Cserni Comparison of the laparoscopic transperitoneal pyeloplasty to the extraperitoneal open and retroperitoneoscopic approaches in children: technical aspects and early outcomes from a developing practice Egyptian Pediatric Association Gazette Pelviureteric junction obstruction Ureteropelvic junction obstruction Hydronephrosis Pyeloplasty Paediatric laparoscopy Laparoscopic pyeloplasty |
| title | Comparison of the laparoscopic transperitoneal pyeloplasty to the extraperitoneal open and retroperitoneoscopic approaches in children: technical aspects and early outcomes from a developing practice |
| title_full | Comparison of the laparoscopic transperitoneal pyeloplasty to the extraperitoneal open and retroperitoneoscopic approaches in children: technical aspects and early outcomes from a developing practice |
| title_fullStr | Comparison of the laparoscopic transperitoneal pyeloplasty to the extraperitoneal open and retroperitoneoscopic approaches in children: technical aspects and early outcomes from a developing practice |
| title_full_unstemmed | Comparison of the laparoscopic transperitoneal pyeloplasty to the extraperitoneal open and retroperitoneoscopic approaches in children: technical aspects and early outcomes from a developing practice |
| title_short | Comparison of the laparoscopic transperitoneal pyeloplasty to the extraperitoneal open and retroperitoneoscopic approaches in children: technical aspects and early outcomes from a developing practice |
| title_sort | comparison of the laparoscopic transperitoneal pyeloplasty to the extraperitoneal open and retroperitoneoscopic approaches in children technical aspects and early outcomes from a developing practice |
| topic | Pelviureteric junction obstruction Ureteropelvic junction obstruction Hydronephrosis Pyeloplasty Paediatric laparoscopy Laparoscopic pyeloplasty |
| url | https://doi.org/10.1186/s43054-025-00360-z |
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