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.	張大宏, 劉鋒, 李新德. 腹腔鏡與開放性離斷式腎盂成形術的療效比較. 中華泌尿外科雜志, 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.	黃濤, 周林玉, 吳奎, 等. 后腹腔鏡與開放腎盂成形手術的療效比較. 中國微創外科雜志, 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.	黃才勝. 后腹腔鏡與開放性離斷式腎盂成形術治療腎孟輸尿管連接部梗阻的效果比較研究. 現代診斷與治療, 2015, 17:4047-4048.
30.	唐鴻. 后腹腔鏡下與開放腎盂離斷成形術療效比較. 中國醫學工程, 2015, 23(2):154-156.
31.	馬為民, 臧任麗, 馬志芳, 等. 微創與開放式術式治療腎孟輸尿管連接部梗阻的臨床療效對比. 國際醫藥衛生導報, 2015, 21(20):2997-3000.
32.	陳日敢, 賴國修, 李騰榮. 開放手術與后腹腔鏡離斷式腎盂成形術治療腎盂輸尿管連接部梗阻的臨床效果比較. 當代醫學, 2011, 11(238):7-8.
33.	邢增術, 肖亞軍, 楊軍, 等. 開放手術與后腹腔鏡離斷式腎盂成形術治療腎盂輸尿管連接部梗阻的臨床效果比較. 臨床泌尿外科雜志, 2010, 25(7):503-506.
34.	吳學良, 張瑞明, 閔新民, 等. 開放手術與腹腔鏡治療腎盂輸尿管連接部狹窄的療效比較. 醫學臨床研究, 2013, 30(3):525-527.
35.	張澤鍵, 王細生, 謝克基, 等. 后腹腔鏡與開放性離斷式腎盂成形術治療腎孟輸尿管連接部梗阻療效比較. 山東醫藥, 2014, 54(13):64-66.
36.	劉志樂, 龍兆麟, 吳世皓, 等. 后腹腔鏡下與開放腎盂離斷成形術的療效比較. 中國醫藥指南, 2014, 12(11):246-247.
37.	王威. 后腹腔鏡下與開放腎盂離斷成形術療效比較. 中國實用醫藥, 2013, 8(24):12-13.
38.	覃樹芳. 腹膜后腹腔鏡與開放性腎盂成形術治療腎盂輸尿管連接部狹窄的比較. 白求恩軍醫學院學報, 2006, 4(3):150-151.
39.	陳超, 王鑫洪, 曹治列, 等. 后腹腔鏡腎盂成形術與開放手術比較. 臨床軍醫雜志, 2010, 38(5):721-723.
40.	方友強, 高新, 周祥福, 等. 后腹腔鏡與開放途徑治療腎盂輸尿管連接部梗阻. 中國內鏡雜志, 2009, 15(5):540-542.
41.	李宏召, 張旭, 黃定平, 等. 后腹腔鏡與開放離斷腎盂成形術的臨床效果比較. 臨床泌尿外科雜志, 2005, 20(9):517-520.
42.	常文亮, 權昌益, 李博, 等. 后腹腔鏡與開放離斷式腎盂成形術的療效比較. 天津醫科大學學報, 2011, 17(1):93-95.
43.	歐平, 鄧曉洪, 鄭軍, 等. 兩種手術治療腎盂輸尿管交界部梗阻的臨床療效及安全性比較. 檢驗醫學與臨床, 2015, 12(14):2028-2031.
44.	李濤, 付生軍, 董治龍, 等. 手助腹腔鏡與開放手術活體供腎取腎術的系統評估. 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. 張大宏, 劉鋒, 李新德. 腹腔鏡與開放性離斷式腎盂成形術的療效比較. 中華泌尿外科雜志, 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. 黃濤, 周林玉, 吳奎, 等. 后腹腔鏡與開放腎盂成形手術的療效比較. 中國微創外科雜志, 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. 黃才勝. 后腹腔鏡與開放性離斷式腎盂成形術治療腎孟輸尿管連接部梗阻的效果比較研究. 現代診斷與治療, 2015, 17:4047-4048.
30. 唐鴻. 后腹腔鏡下與開放腎盂離斷成形術療效比較. 中國醫學工程, 2015, 23(2):154-156.
31. 馬為民, 臧任麗, 馬志芳, 等. 微創與開放式術式治療腎孟輸尿管連接部梗阻的臨床療效對比. 國際醫藥衛生導報, 2015, 21(20):2997-3000.
32. 陳日敢, 賴國修, 李騰榮. 開放手術與后腹腔鏡離斷式腎盂成形術治療腎盂輸尿管連接部梗阻的臨床效果比較. 當代醫學, 2011, 11(238):7-8.
33. 邢增術, 肖亞軍, 楊軍, 等. 開放手術與后腹腔鏡離斷式腎盂成形術治療腎盂輸尿管連接部梗阻的臨床效果比較. 臨床泌尿外科雜志, 2010, 25(7):503-506.
34. 吳學良, 張瑞明, 閔新民, 等. 開放手術與腹腔鏡治療腎盂輸尿管連接部狹窄的療效比較. 醫學臨床研究, 2013, 30(3):525-527.
35. 張澤鍵, 王細生, 謝克基, 等. 后腹腔鏡與開放性離斷式腎盂成形術治療腎孟輸尿管連接部梗阻療效比較. 山東醫藥, 2014, 54(13):64-66.
36. 劉志樂, 龍兆麟, 吳世皓, 等. 后腹腔鏡下與開放腎盂離斷成形術的療效比較. 中國醫藥指南, 2014, 12(11):246-247.
37. 王威. 后腹腔鏡下與開放腎盂離斷成形術療效比較. 中國實用醫藥, 2013, 8(24):12-13.
38. 覃樹芳. 腹膜后腹腔鏡與開放性腎盂成形術治療腎盂輸尿管連接部狹窄的比較. 白求恩軍醫學院學報, 2006, 4(3):150-151.
39. 陳超, 王鑫洪, 曹治列, 等. 后腹腔鏡腎盂成形術與開放手術比較. 臨床軍醫雜志, 2010, 38(5):721-723.
40. 方友強, 高新, 周祥福, 等. 后腹腔鏡與開放途徑治療腎盂輸尿管連接部梗阻. 中國內鏡雜志, 2009, 15(5):540-542.
41. 李宏召, 張旭, 黃定平, 等. 后腹腔鏡與開放離斷腎盂成形術的臨床效果比較. 臨床泌尿外科雜志, 2005, 20(9):517-520.
42. 常文亮, 權昌益, 李博, 等. 后腹腔鏡與開放離斷式腎盂成形術的療效比較. 天津醫科大學學報, 2011, 17(1):93-95.
43. 歐平, 鄧曉洪, 鄭軍, 等. 兩種手術治療腎盂輸尿管交界部梗阻的臨床療效及安全性比較. 檢驗醫學與臨床, 2015, 12(14):2028-2031.
44. 李濤, 付生軍, 董治龍, 等. 手助腹腔鏡與開放手術活體供腎取腎術的系統評估. 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