Long term outcomes of laparoscopic and open modified lich-gregoir reimplantation in adults: a multicentric comparative study

Background and Objective: Obstructive ureteral pathologies in adult patients are most commonly due to ureteral strictures and secondary to surgical interventions. In this study, we aimed to compare open and iaparoscopic modified Lich-Gregoir ureteral reimplantation with regards to outcomes in benign ureteral pathologies in adult patients

Methods: Between December 2008 and December 2014, 32 open cases and 29 laparoscopic cases were performed as per the data retrieved from surgical databases. All laparoscopic procedures were performed in Bakirkoy Dr. Sadi Konuk Training and Research Hospital [BEAH] and all open ureteral reimplantation procedures in Kartal Dr Lutfi Kirdar Training and Research Hospital [KEAH] and Okmeydani Training and Research Hospital [OEAH]

Results: The mean operation time was significantly lower in the group of patients operated with open group [142.5 minutes versus 188.9 minutes; P< 0.0001]. The mean duration of follow-up was longer in the laparoscopy group [31 versus 28 months; p< 0.0001]. The mean amount of operation associated blood loss was significantly lower in patients operated laparoscopically [93.7 ml versus 214 ml; P< 0.0001]. The mean VAS score obtained six hours after surgery was 6.6 +/- 0.8 in open group, and 5.8 +/- 0.7 in laparoscopic group [p=0.0004]. The mean VAS scores measured at post-operative day 1 was 4.5 +/- 0.7 in open group and 3.7 +/-0.9 in laparoscopy group. Time required to achieve the pre-operative capability of daily activities was significantly longer in open group [15 +/- 1.4 days vs 11 +/- 1.4 days; p< 0.0001]

Conclusion: Despite open techniques provide shorter operation time and laparoscopic techniques require long learning curve, we think that laparoscopic techniques are superior to open ones since that they provide a better post-operative comfort and are better tolerated in terms of complications

Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis

Objective: To compare the safety and effectiveness of flexible ureteroscopy [F-URS] with transperitoneal laparoscopic ureterolithotomy [TPLU] in cases of obstructive pyelonephritis secondary to large proximal ureteral stones

Methods: A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU [Group I], and 20 patients were treated with F-URS [Group II]. Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group

Results: It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone-free rate [100% vs 80%. p=0.043] and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain [p=0.008], a shorter hospital stay [p<0.001] and a faster return to daily activities [p<0.001]

Conclusions: The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities