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Evaluation of Open vs Laparoscopic Pyeloplasty in Children
The mean GFR preoperatively in the laparoscopic pyeloplasty followed by right-sided lesions, which corresponds to the literature
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group was 38.05; the majority of patients had a GFR between 30 and study, which offers 66% when compared to the opposite side.
50. Three individuals had GFRs ranging from 15 to 20. In comparison, Male children are more typically impacted than female by a factor
the average postoperative GFR improved to 40.15 (Table 2). of three, although the literature study revealed a factor of two.
The DTPA renogram demonstrated improved differential According to the symptoms, the majority of the children had a
renal function in 58 of the 70 patients, 30 of whom were from the mass abdomen (62.8 %), with other symptoms including UTI and
laparoscopic group and 28 of whom were from the open group. pain being less common. To avoid kidney injury, some studies
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In 10 patients, 5 from the open group and 5 from the laparoscopic have advocated early treatment. A small number of studies
group, the DTPA renogram remained unaltered (Table 2). The have found that affected kidneys with acceptable differential
remaining two showed just a little drop in differential function. renal function at the time of diagnosis are less likely to have renal
The two patients had pyeloplasty redone. Both were members of function deterioration after surgery. Differential renal function
the open group. The postoperative analgesic demand was much did not improve following pyeloplasty, according to previous
lower in laparoscopic pyeloplasty compared to open pyeloplasty. investigations, regardless of prior renal functional condition. 7
The length of analgesic required was also much shorter in the To distinguish the blocked PUJ, diuretic renography (DTPA) has
laparoscopic group. The mean hospital stay after laparoscopic been frequently used. Few researchers, however, have questioned
pyeloplasty was 3.15 days, which was substantially smaller than the the interpretation of diuretic renography obstructive patterns to
open group’s mean of 8.30 days. The average follow-up in available diagnose PUJ blockage. The use of a 20-minute washout after a
patients was 33.5 months, and 34.5 months in laparoscopic cases. diuretic challenge to diagnose blockage is effective in symptomatic
There was just one conversion from laparoscopic to open surgery older children and adults, but assuming the same criteria can
in the laparoscopic group due to technical difficulties. Owing to be applied to an asymptomatic group of young children has
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a significant decline in differential renal function, two children aroused debate. Both the open and laparoscopic groups had a
in the open group had redo pyeloplasty. When compared to the postoperative diuretic renogram to see whether the differential
open group, patients in the laparoscopic group had less scarring renal function and GFR had improved. Preoperatively, the open
at the incision site. group’s mean GFR was 38.32. Five individuals had the lowest GFR of
15–20. In comparison, the average postoperative GFR improved by
40.8. Preoperatively, the mean GFR in the laparoscopic group was
dIscussIon 39.8, with the majority of patients having a GFR between 30 and
Among the 70 patients, 21 were found antenatally, accounting for 50. Three individuals had the lowest GFR of 15–20. In comparison,
30% of instances, although, in the literature, approximately 50% the average postoperative GFR improved by 41.2%. There was
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of patients have been observed antenatally. Of the 21 individuals, no significant difference in GFR improvement between the two
11 were operated on before the age of 1 year, while the rest were groups (p >0.05; Table 3). The DTPA renogram revealed improved
operated on before the age of 5 years. According to our series, differential renal function in 58 of the 70 patients, with 30 patients
left-sided lesions were the most prevalent, accounting for 57.14%, having undergone laparoscopic surgery and 28 had undergone

Table 2: Descriptive statistics of study subjects in the two groups (n = 70)
Group N Mean Std. deviation t value p value
Preop GFR (mL/min) Open 35 37.86 16 0.049 >0.05
Lap 35 38.05 16.4
Preop differential function Open 35 38.50 10.2 0.072 >0.05
Lap 35 38.33 9.7
Postop GFR (mL/min) Open 35 41.02 14.2 0.925 >0.05
Lap 35 40.15 11.6
Postop differential function Open 35 41.31 9.1 0.136 >0.05
Lap 35 41.00 9.4
Preop, preoperative; Postop, postoperative
Table 3: Comparison of means of certain variables between the two groups
Group N Mean Std. deviation t value p value
Preop GFR (mL/min) Open 35 37.86 16 0.049 >0.05
Lap 35 38.05 16.4
Preop differential function Open 35 38.50 10.2 0.072 >0.05
Lap 35 38.33 9.7
Postop GFR (mL/min) Open 35 41.02 14.2 0.925 >0.05
Lap 35 40.15 11.6
Postop differential function Open 35 41.31 9.1 0.136 >0.05
Lap 35 41.00 9.4
Preop, preoperative; Postop, postoperative

World Journal of Laparoscopic Surgery, Volume 14 Issue 3 (September–December 2021) 175