Meta-analysis of transperitoneal versus retroperitoneal approaches of laparoscopic pyeloplasty for ureteropelvic junction obstruction

Abstract

Objective: To compare transperitoneal and retroperitoneal approaches of laparoscopic pyeloplasty (LP) for ureteropelvic junction obstruction (UPJO) with meta-analysis.

Materials and methods: All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing transperitoneal LP (TLP) and retroperitoneal LP (RLP) were included systematically using Medline, Embase, and The Cochrane Library. Outcomes were success rate, complications, operative time, conversion, presence of a crossing vessel, and length of hospital stay. Two reviewers independently extracted data and assessed quality. Meta-analysis used both fixed and random effects models with dichotomous data reported as relative risk and continuous data as a weighted mean difference with 95% confidence intervals.

Results: One RCT and eight CCTs were identified (reporting 776 participants). Meta-analysis showed that TLP was associated with an operative time reduction of about 40 minutes (weighted mean difference -43.85, 95% confidence interval -58.06 to -27.63; P<.00001) and significantly lower conversion rate (relative risk [RR] 0.39, 95% confidence interval 0.21-0.74; P=.004) compared with RLP. The two approaches were similar in terms of presence of a crossing vessel (RR 1.24, 95% confidence interval 0.83-1.86; P=.28), length of hospital stay (weighted mean difference -0.24, 95% confidence interval -0.75 to 0.26; P=.35), success rate (RR 1.03, 95% confidence interval 0.97-1.09; P=.76), and complications (RR 0.83, 95% confidence interval 0.17-1.26; P=.61).

Conclusions: LP as a minimally invasive treatment for UPJO can be performed through both the transperitoneal and retroperitoneal approaches, and either approach is associated with a high success rate and a low complication rate, although TLP provides a shorter operative time and lower conversion rate.