Efficacy and Safety of Laparoscopic Pyeloplasty versus Open Pyeloplasty for Ureterpelvic Junction Obstruction: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 LITao ,  FUChong-de , CHENGuang-yu , WEIQiao-hong , TANGYao , JIAOLin , XIESheng-tao

Department of Urology, Xi'an Aerospace General Hospital, Xi'an 710100, China;

Corresponding author：

FUChong-de, Email: fchd1984@163.com

Keywords：

Ureterpelvic junction obstruction; Open pyeloplasty; Laparoscopic pyeloplasty; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20160047

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the efficacy and safety of laparoscopic pyeloplasty (LP) versus open pyeloplasty (OP) for patients with ureterpelvic junction obstruction (UPJO). Methods We electronically searched databases including PubMed, The Cochrane Library (Issue 11, 2015), Sciverse, VIP, WanFang Data and CNKI from inception to Dec., 2015, to collect randomized controlled trials (RCTs) and non-randomized clinical controlled trials (CCTs) about LP versus OP for UPJO patients. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 38 studies including 8 RCTs and 30 CCTs were included. The results of meta-analysis based on RCTs showed that, there were no significant differences in successful operation rate (OR=0.50, 95%CI 0.20 to 1.24, P=0.13) and the incidence of postoperative complications (OR=1.19, 95%CI 0.61 to 2.31, P=0.62) between the OP group and the LP group; The operation time of the OP group was shorter than that of the LP group (MD=62.07, 95%CI 3.94 to 120.19, P=0.04), but this difference was not found in subgroup analysis of retroperitoneal approach (MD=49.99, 95%CI -23.69 to 123.67, P=0.18); The hospital stay of the LP group was shorter than that of the OP group (MD=-3.96, 95%CI -4.92 to -2.99, P<0.0001). The results of meta-analysis based on CCTs showed that, there was no significant difference in successful operation rate between two groups (OR=1.34, 95%CI 0.84 to 2.16, P=0.22), and similar results were found in subgroup analysis of transperitoneal or retroperitoneal approaches; The incidence of postoperative complications of the LP group was shorter than that of the OP group (OR=0.51, 95%CI 0.37 to 0.69, P<0.0001); The hospital stay of the LP group was shorter than that of the OP group (MD=-3.87, 95%CI -4.90 to -2.83, P<0.00001) and similar result was found in subgroup analysis of transperitoneal approach (MD=-4.08, 95%CI -5.21 to -2.95, P<0.0001); There was no significant difference between two groups in operation time (MD=24.15, 95%CI -7.56 to 55.87, P=0.14). Conclusion Current evidence shows that, the successful operation rate between LP and OP operations is similar, but the LP operation has less incidence of postoperative complication and shorter hospital stay. Due to limited quality of the included studies, the above conclusion needs more high quality studies to verify.

Citation： LITao, FUChong-de, CHENGuang-yu, WEIQiao-hong, TANGYao, JIAOLin, XIESheng-tao. Efficacy and Safety of Laparoscopic Pyeloplasty versus Open Pyeloplasty for Ureterpelvic Junction Obstruction: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2016, 16(3): 292-303. doi: 10.7507/1672-2531.20160047 Copy

1.	Polok M, Chrzan R, Veenboer P, et al. Nondismembered pyeloplasty in a pediatric population:results of 34 open and laparoscopic procedures. Urology, 2011, 78(4):891-894.
2.	Knoedler J, Han L, Granberg C, et al. Population-based comparison of laparoscopic and open pyeloplasty in paediatric pelvi-ureteric junction obstruction. BJU Int, 2013, 111(7):1141-1147.
3.	Simforoosh N, Basiri A, Tabibi A, et al. A comparison between laparoscopic and open pyeloplasty in patients with ureteropelvic junction obstruction. Urol J, 2004, 1(3):165-169.
4.	Ravish IR, Nerli RB, Reddy MN, et al. Laparoscopic pyeloplasty compared with open pyeloplasty in children. J Endourol, 2007, 21(8):897-902.
5.	Varda BK, Johnson EK, Clark C, et al. National trends of perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty. J Urol, 2014, 191(4):1090-1095.
6.	Tong Q, Zheng L, Tang S, et al. Comparison of laparoscopic-assisted versus open dismembered pyeloplasty for ureteropelvic junction obstruction in infants:intermediate results. Urology, 2009, 74(4):889-893.
7.	Wang X, Zhang Z, Peng N, et al. Retroperitoneal laparoscopic versus open dismembered pyeloplasty for ureteropelvic junction obstruction. J X-Ray Sci Technol, 2013, 21(3):429-439.
8.	Bauer JJ, Bishoff JT, Moore RG, et al. Laparoscopic versus open pyeloplasty:assessment of objective and subjective outcome. J Urol, 1999, 162(3 Pt 1):692-695.
9.	SoulieM, Thoulouzan M, Seguin P, et al. Retroperitoneal laparoscopic versus open pyeloplasty with a minimal incision:comparison of two surgical approaches. Urology, 2001, 57(3):443-437.
10.	Simforoosh N, Basiri A, Tabibi A, et al. A comparison between laparoscopic and open pyeloplasty in patients with ureteropelvic junction obstruction. Urol J, 2004, 1(3):165-169.
11.	Baldwin DD, Dunbar JA, Wells N, et al. Single-center comparison of laparoscopic pyeloplasty, Acucise endopyelotomy, and open pyeloplasty. J Endourol, 2003, 17(3):155-160.
12.	Bonnard A, Fouquet V, Carricaburu E, et al. Retroperitoneal laparoscopic versus open pyeloplasty in children. J Urol, 2005, 173(5):1710-1713.
13.	Zhang X, Li HZ, Ma X, et al. Retrospective comparison of retroperitoneal laparoscopic versus open dismembered pyeloplasty for ureteropelvic junction obstruction. J Urol, 2006, 176(3):1077-1080.
14.	Calvert RC, Morsy MM, Zelhof B, et al. Comparison of laparoscopic and open pyeloplasty in 100 patients with pelvi-ureteric junction obstruction. Surg Endosc, 2008, 22(2):411-414.
15.	张大宏, 刘锋, 李新德. 腹腔镜与开放性离断式肾盂成形术的疗效比较. 中华泌尿外科杂志, 2007, 28(3):171-174.
16.	Ravish IR, Nerli RB, Reddy MN, et al. Laparoscopic pyeloplasty compared with open pyeloplasty in children. J Endourol, 2007, 21(8):897-902.
17.	Piaggio LA, Franc-Guimond J, Noh PH, et al. Transperitoneal laparoscopic pyeloplasty for primary repair of ureteropelvic junction obstruction in infants and children:comparison with open surgery. J Urol, 2007, 178(4 Pt 2):1579-1583.
18.	黄涛, 周林玉, 吴奎, 等. 后腹腔镜与开放肾盂成形手术的疗效比较. 中国微创外科杂志, 2008, 8(10):880-882.
19.	Vemulakonda VM, Cowan CA, Lendvay TS, et al. Surgical management of congenital ureteropelvic junction obstruction:a Pediatric Health Information System database study. J Urol, 2008, 180(4 Suppl):1689-1692.
20.	Valla JS, Breaud J, Griffin SJ, et al. Retroperitoneoscopic vs open dismembered pyeloplasty for ureteropelvic junction obstruction in children. J Pediatr Urol, 2009, 5(5):368-373.
21.	Wang L, Qin W, Tian F, et al. Cytokine responses following laparoscopic or open pyeloplasty in children. Surg Endosc, 2009, 23(3):544-549.
22.	Penn HA, Gatti JM, Hoestje SM, et al. Laparoscopic versus open pyeloplasty in children:preliminary report of a prospective randomized trial. J Urol, 2010, 184(2):690-695.
23.	Umari P, Lissiani A, Trombetta C, et al. Comparison of open and laparoscopic pyeloplasty in ureteropelvic junction obstruction surgery:report of 49 cases. Arch Ital Urol Androl, 2011, 83(4):169-174.
24.	Bansal P, Gupta A, Mongha R, et al. Laparoscopic versus open pyeloplasty:comparison of two surgical approaches-a single centre experience of three years. Indian J Surg, 2011, 73(4):264-267.
25.	Polok M, Chrzan R, Veenboer P, et al. Nondismembered pyeloplasty in a pediatric population:results of 34 open and laparoscopic procedures. Urology, 2011, 78(4):891-894.
26.	van der Toorn F, van den Hoek J, Wolffenbuttel KP, et al. Laparoscopic transperitoneal pyeloplasty in children from age of 3 years:our clinical outcomes compared with open surgery. J Pediatr Urol, 2013, 9(2):161-168.
27.	Herndon CD, Herbst K, Smith C. The transition from open to laparoscopic pediatric pyeloplasty:a single-surgeon experience. J Pediatr Urol, 2013, 9(4):409-414.
28.	Garg M, Singh V, Sinha RJ, et al. Prospective randomized comparison of retroperitoneoscopic vs open pyeloplasty with minimal incision:subjective and objective assessment in adults. Urology, 2014;, 83(4):805-811.
29.	黄才胜. 后腹腔镜与开放性离断式肾盂成形术治疗肾孟输尿管连接部梗阻的效果比较研究. 现代诊断与治疗, 2015, 17:4047-4048.
30.	唐鸿. 后腹腔镜下与开放肾盂离断成形术疗效比较. 中国医学工程, 2015, 23(2):154-156.
31.	马为民, 臧任丽, 马志芳, 等. 微创与开放式术式治疗肾孟输尿管连接部梗阻的临床疗效对比. 国际医药卫生导报, 2015, 21(20):2997-3000.
32.	陈日敢, 赖国修, 李腾荣. 开放手术与后腹腔镜离断式肾盂成形术治疗肾盂输尿管连接部梗阻的临床效果比较. 当代医学, 2011, 11(238):7-8.
33.	邢增术, 肖亚军, 杨军, 等. 开放手术与后腹腔镜离断式肾盂成形术治疗肾盂输尿管连接部梗阻的临床效果比较. 临床泌尿外科杂志, 2010, 25(7):503-506.
34.	吴学良, 张瑞明, 闵新民, 等. 开放手术与腹腔镜治疗肾盂输尿管连接部狭窄的疗效比较. 医学临床研究, 2013, 30(3):525-527.
35.	张泽键, 王细生, 谢克基, 等. 后腹腔镜与开放性离断式肾盂成形术治疗肾孟输尿管连接部梗阻疗效比较. 山东医药, 2014, 54(13):64-66.
36.	刘志乐, 龙兆麟, 吴世皓, 等. 后腹腔镜下与开放肾盂离断成形术的疗效比较. 中国医药指南, 2014, 12(11):246-247.
37.	王威. 后腹腔镜下与开放肾盂离断成形术疗效比较. 中国实用医药, 2013, 8(24):12-13.
38.	覃树芳. 腹膜后腹腔镜与开放性肾盂成形术治疗肾盂输尿管连接部狭窄的比较. 白求恩军医学院学报, 2006, 4(3):150-151.
39.	陈超, 王鑫洪, 曹治列, 等. 后腹腔镜肾盂成形术与开放手术比较. 临床军医杂志, 2010, 38(5):721-723.
40.	方友强, 高新, 周祥福, 等. 后腹腔镜与开放途径治疗肾盂输尿管连接部梗阻. 中国内镜杂志, 2009, 15(5):540-542.
41.	李宏召, 张旭, 黄定平, 等. 后腹腔镜与开放离断肾盂成形术的临床效果比较. 临床泌尿外科杂志, 2005, 20(9):517-520.
42.	常文亮, 权昌益, 李博, 等. 后腹腔镜与开放离断式肾盂成形术的疗效比较. 天津医科大学学报, 2011, 17(1):93-95.
43.	欧平, 邓晓洪, 郑军, 等. 两种手术治疗肾盂输尿管交界部梗阻的临床疗效及安全性比较. 检验医学与临床, 2015, 12(14):2028-2031.
44.	李涛, 付生军, 董治龙, 等. 手助腹腔镜与开放手术活体供肾取肾术的系统评估. 器官移植, 2014, 5(2):68-73.

1. Polok M, Chrzan R, Veenboer P, et al. Nondismembered pyeloplasty in a pediatric population:results of 34 open and laparoscopic procedures. Urology, 2011, 78(4):891-894.
2. Knoedler J, Han L, Granberg C, et al. Population-based comparison of laparoscopic and open pyeloplasty in paediatric pelvi-ureteric junction obstruction. BJU Int, 2013, 111(7):1141-1147.
3. Simforoosh N, Basiri A, Tabibi A, et al. A comparison between laparoscopic and open pyeloplasty in patients with ureteropelvic junction obstruction. Urol J, 2004, 1(3):165-169.
4. Ravish IR, Nerli RB, Reddy MN, et al. Laparoscopic pyeloplasty compared with open pyeloplasty in children. J Endourol, 2007, 21(8):897-902.
5. Varda BK, Johnson EK, Clark C, et al. National trends of perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty. J Urol, 2014, 191(4):1090-1095.
6. Tong Q, Zheng L, Tang S, et al. Comparison of laparoscopic-assisted versus open dismembered pyeloplasty for ureteropelvic junction obstruction in infants:intermediate results. Urology, 2009, 74(4):889-893.
7. Wang X, Zhang Z, Peng N, et al. Retroperitoneal laparoscopic versus open dismembered pyeloplasty for ureteropelvic junction obstruction. J X-Ray Sci Technol, 2013, 21(3):429-439.
8. Bauer JJ, Bishoff JT, Moore RG, et al. Laparoscopic versus open pyeloplasty:assessment of objective and subjective outcome. J Urol, 1999, 162(3 Pt 1):692-695.
9. SoulieM, Thoulouzan M, Seguin P, et al. Retroperitoneal laparoscopic versus open pyeloplasty with a minimal incision:comparison of two surgical approaches. Urology, 2001, 57(3):443-437.
10. Simforoosh N, Basiri A, Tabibi A, et al. A comparison between laparoscopic and open pyeloplasty in patients with ureteropelvic junction obstruction. Urol J, 2004, 1(3):165-169.
11. Baldwin DD, Dunbar JA, Wells N, et al. Single-center comparison of laparoscopic pyeloplasty, Acucise endopyelotomy, and open pyeloplasty. J Endourol, 2003, 17(3):155-160.
12. Bonnard A, Fouquet V, Carricaburu E, et al. Retroperitoneal laparoscopic versus open pyeloplasty in children. J Urol, 2005, 173(5):1710-1713.
13. Zhang X, Li HZ, Ma X, et al. Retrospective comparison of retroperitoneal laparoscopic versus open dismembered pyeloplasty for ureteropelvic junction obstruction. J Urol, 2006, 176(3):1077-1080.
14. Calvert RC, Morsy MM, Zelhof B, et al. Comparison of laparoscopic and open pyeloplasty in 100 patients with pelvi-ureteric junction obstruction. Surg Endosc, 2008, 22(2):411-414.
15. 张大宏, 刘锋, 李新德. 腹腔镜与开放性离断式肾盂成形术的疗效比较. 中华泌尿外科杂志, 2007, 28(3):171-174.
16. Ravish IR, Nerli RB, Reddy MN, et al. Laparoscopic pyeloplasty compared with open pyeloplasty in children. J Endourol, 2007, 21(8):897-902.
17. Piaggio LA, Franc-Guimond J, Noh PH, et al. Transperitoneal laparoscopic pyeloplasty for primary repair of ureteropelvic junction obstruction in infants and children:comparison with open surgery. J Urol, 2007, 178(4 Pt 2):1579-1583.
18. 黄涛, 周林玉, 吴奎, 等. 后腹腔镜与开放肾盂成形手术的疗效比较. 中国微创外科杂志, 2008, 8(10):880-882.
19. Vemulakonda VM, Cowan CA, Lendvay TS, et al. Surgical management of congenital ureteropelvic junction obstruction:a Pediatric Health Information System database study. J Urol, 2008, 180(4 Suppl):1689-1692.
20. Valla JS, Breaud J, Griffin SJ, et al. Retroperitoneoscopic vs open dismembered pyeloplasty for ureteropelvic junction obstruction in children. J Pediatr Urol, 2009, 5(5):368-373.
21. Wang L, Qin W, Tian F, et al. Cytokine responses following laparoscopic or open pyeloplasty in children. Surg Endosc, 2009, 23(3):544-549.
22. Penn HA, Gatti JM, Hoestje SM, et al. Laparoscopic versus open pyeloplasty in children:preliminary report of a prospective randomized trial. J Urol, 2010, 184(2):690-695.
23. Umari P, Lissiani A, Trombetta C, et al. Comparison of open and laparoscopic pyeloplasty in ureteropelvic junction obstruction surgery:report of 49 cases. Arch Ital Urol Androl, 2011, 83(4):169-174.
24. Bansal P, Gupta A, Mongha R, et al. Laparoscopic versus open pyeloplasty:comparison of two surgical approaches-a single centre experience of three years. Indian J Surg, 2011, 73(4):264-267.
25. Polok M, Chrzan R, Veenboer P, et al. Nondismembered pyeloplasty in a pediatric population:results of 34 open and laparoscopic procedures. Urology, 2011, 78(4):891-894.
26. van der Toorn F, van den Hoek J, Wolffenbuttel KP, et al. Laparoscopic transperitoneal pyeloplasty in children from age of 3 years:our clinical outcomes compared with open surgery. J Pediatr Urol, 2013, 9(2):161-168.
27. Herndon CD, Herbst K, Smith C. The transition from open to laparoscopic pediatric pyeloplasty:a single-surgeon experience. J Pediatr Urol, 2013, 9(4):409-414.
28. Garg M, Singh V, Sinha RJ, et al. Prospective randomized comparison of retroperitoneoscopic vs open pyeloplasty with minimal incision:subjective and objective assessment in adults. Urology, 2014;, 83(4):805-811.
29. 黄才胜. 后腹腔镜与开放性离断式肾盂成形术治疗肾孟输尿管连接部梗阻的效果比较研究. 现代诊断与治疗, 2015, 17:4047-4048.
30. 唐鸿. 后腹腔镜下与开放肾盂离断成形术疗效比较. 中国医学工程, 2015, 23(2):154-156.
31. 马为民, 臧任丽, 马志芳, 等. 微创与开放式术式治疗肾孟输尿管连接部梗阻的临床疗效对比. 国际医药卫生导报, 2015, 21(20):2997-3000.
32. 陈日敢, 赖国修, 李腾荣. 开放手术与后腹腔镜离断式肾盂成形术治疗肾盂输尿管连接部梗阻的临床效果比较. 当代医学, 2011, 11(238):7-8.
33. 邢增术, 肖亚军, 杨军, 等. 开放手术与后腹腔镜离断式肾盂成形术治疗肾盂输尿管连接部梗阻的临床效果比较. 临床泌尿外科杂志, 2010, 25(7):503-506.
34. 吴学良, 张瑞明, 闵新民, 等. 开放手术与腹腔镜治疗肾盂输尿管连接部狭窄的疗效比较. 医学临床研究, 2013, 30(3):525-527.
35. 张泽键, 王细生, 谢克基, 等. 后腹腔镜与开放性离断式肾盂成形术治疗肾孟输尿管连接部梗阻疗效比较. 山东医药, 2014, 54(13):64-66.
36. 刘志乐, 龙兆麟, 吴世皓, 等. 后腹腔镜下与开放肾盂离断成形术的疗效比较. 中国医药指南, 2014, 12(11):246-247.
37. 王威. 后腹腔镜下与开放肾盂离断成形术疗效比较. 中国实用医药, 2013, 8(24):12-13.
38. 覃树芳. 腹膜后腹腔镜与开放性肾盂成形术治疗肾盂输尿管连接部狭窄的比较. 白求恩军医学院学报, 2006, 4(3):150-151.
39. 陈超, 王鑫洪, 曹治列, 等. 后腹腔镜肾盂成形术与开放手术比较. 临床军医杂志, 2010, 38(5):721-723.
40. 方友强, 高新, 周祥福, 等. 后腹腔镜与开放途径治疗肾盂输尿管连接部梗阻. 中国内镜杂志, 2009, 15(5):540-542.
41. 李宏召, 张旭, 黄定平, 等. 后腹腔镜与开放离断肾盂成形术的临床效果比较. 临床泌尿外科杂志, 2005, 20(9):517-520.
42. 常文亮, 权昌益, 李博, 等. 后腹腔镜与开放离断式肾盂成形术的疗效比较. 天津医科大学学报, 2011, 17(1):93-95.
43. 欧平, 邓晓洪, 郑军, 等. 两种手术治疗肾盂输尿管交界部梗阻的临床疗效及安全性比较. 检验医学与临床, 2015, 12(14):2028-2031.
44. 李涛, 付生军, 董治龙, 等. 手助腹腔镜与开放手术活体供肾取肾术的系统评估. 器官移植, 2014, 5(2):68-73.

Previous Article
Diagnostic Value of Presepsin for Sepsis: A Meta-analysis
Next Article
Efficacy and Safety of Early Oxygen Therapy for Acute Myocardial Infarction: A Meta-analysis

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Laparoscopic Pyeloplasty versus Open Pyeloplasty for Ureterpelvic Junction Obstruction: A Systematic Review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content