BERKELEY, CA (UroToday.com) - A study by Neheman, et al compared the outcomes of laparoscopic urinary tract reconstruction in children weighing less than 10 kg with a weight-matched cohort undergoing open urinary tract reconstruction surgery. This was performed in a retrospective manner. They evaluated all children 10 kg or less at the time of surgery that underwent open or laparoscopic pyeloplasty, transuretero-ureterostomy and ipsilateral uretero-ureterostomy over a 7 year time frame. They compared body weight, age, sex, diagnosis, type of procedure, operative time, estimated blood loss, pre- and postoperative hemoglobin levels, length of hospitalization, length of follow up, use of drains and stents, intra-operative and postoperative analgesic requirement, need for readmission, subsequent procedures, costs, complications and re-operations.

The group found that they had 52 patients. There were 23 patients who underwent a laparoscopic reconstruction and 29 who had open reconstructions. The median weight was 6.2 kg with a range of 3.9-10 in the laparoscopic group and 6.5 kg with a range of 4.7-9.6 in the open reconstruction group. The follow up time was a mean of 9 months in the laparoscopic group and 31 months in the open group. The mean operative time for the laparoscopic group was almost doubled with 237 minutes as compared to 128 minutes in the open group. They found no difference in blood loss, analgesic requirement, success rates, or complications. They did find that the overall length of stay was shorter for the laparoscopic group than for the open group. The difference was measured in days and was 1 day less for the laparoscopic group. They state that there were no differences in hospital costs between the two groups.

They concluded that laparoscopic reconstructive surgery for congenital urologic anomalies is safe and effective in infants and can be performed with outcomes comparable to that of open surgery. It seems that their complication rate, although small is quite significant in regards to leakage, re-stenting and also reoperation. I do agree that laparoscopic reconstruction is feasible in the infants but one must heed the warning that it is quite difficult. Intracorporeal suturing with such small anatomic limitations is quite tedious and requires an extensive amount of practice to achieve a mastery that would ensure the patient to have the same type of operation done whether laparoscopic or open.

I find it interesting that they found no difference in hospital cost between the 2 groups. Typically the laparoscopic procedures, because of disposable items cost more, but this may have been offset with the longer hospital stay for the open group. If non-disposable items were used during the laparoscopic procedure, it may have saved even more in hospital cost.

Amos Neheman, Paul H. Noh, Lisandro Piaggio, Ricardo González

Journal of Pediatric Urology, 2008
doi: 10.1016/j.jpurol.2007.10.012

UroToday.com Pediatric Urology Section

Written by Pasquale Casale, MD, a Contributing Editor with UroToday.

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