Service d'Urologie, Andrologie et Transplantation Rénale, CHU Rangueil, Toulouse, France.
Urology. 2010 Oct;76(4):877-81. doi: 10.1016/j.urology.2009.11.062. Epub 2010 Feb 13.
To compare both approaches of laparoscopic pyeloplasty, transperitoneal vs retroperitoneoscopy.
A total of 65 procedures were performed in 62 patients, 36 females and 26 males. Laparoscopic pyeloplasty with Anderson Hynes technique was performed transperitoneal in 34 cases and retroperitoneal in 31 cases. Parameters studied were the operative duration, the rate of conversion to open approach, transposition of crossing vessel, complications and reintervention, results, and the duration of hospitalization. Then, overall success rate for both approaches was evaluated in the presence or absence of crossing vessels, and if transposition of crossing vessel was performed vs without.
The overall success rate for both procedures was 85% (87% for the retroperitoneal vs 82% for the transperitoneal approach). The mean operative duration was 231.69 ± 59.97 and 194.76 ± 25.37 minutes for the retroperitoneal and transperitoneal approaches, respectively (P = .029). The rate of conversion was 19.35% (6 of 31) and 2.9% (1 of 34) for the retroperitoneal and transperitoneal approaches, respectively (P = .047). No significant statistical difference was noted between both techniques related to the age of patient, the hospital stay, and intraoperative and postoperative complications. Transposition of crossing vessel had no effect on the results (81.25% with transposition and 80% if not, P = .93).
Retroperitoneoscopic approach is associated with longer operative time and more conversion rate than transperitoneoscopy. However, the overall outcomes of laparoscopic transperitoneal pyeloplasty vs retroperitoneoscopic were comparable.
比较腹腔镜肾盂成形术的两种途径，经腹腔与后腹腔。
总共在 62 名患者（36 名女性和 26 名男性）中进行了 65 例手术。经腹腔行 Anderson Hynes 技术腹腔镜肾盂成形术 34 例，后腹腔 31 例。研究的参数包括手术时间、转为开放手术的比率、交叉血管转位、并发症和再干预、结果以及住院时间。然后，在存在或不存在交叉血管的情况下，评估两种方法的总体成功率，以及是否进行交叉血管转位与不进行交叉血管转位的情况。
两种方法的总体成功率均为 85%（后腹腔为 87%，经腹腔为 82%）。平均手术时间分别为 231.69 ± 59.97 分钟和 194.76 ± 25.37 分钟（P =.029）。后腹腔和经腹腔途径的转化率分别为 19.35%（6/31）和 2.9%（1/34）（P =.047）。两种技术在患者年龄、住院时间以及术中术后并发症方面均无显著统计学差异。交叉血管转位对结果无影响（转位者为 81.25%，未转位者为 80%，P =.93）。
与经腹腔相比，后腹腔镜途径的手术时间更长，转化率更高。然而，腹腔镜经腹腔肾盂成形术与后腹腔镜肾盂成形术的总体结果相当。
