Postoperative Inflammatory Response and Recovery following Pediatric Pyeloplasty: A Comparative Study of Laparoscopic and Open Approaches.

BACKGROUND

Pelviureteric junction obstruction (PUJO) is a leading cause of pediatric hydronephrosis. Open pyeloplasty (OP) remains the standard treatment, but laparoscopic pyeloplasty (LP) is increasingly adopted. Comparative pediatric data on inflammatory and perioperative outcomes remain limited.

OBJECTIVE

To compare perioperative outcomes, inflammatory responses, and recovery profiles between OP and LP in children with PUJO.

MATERIALS AND

METHODS

We conducted a prospective, nonrandomized, comparative study (December 2017-June 2025) including pediatric patients undergoing pyeloplasty. Patients were allocated to OP or LP based on surgical unit assignment, with family preference considered. All eligible families were counseled about both surgical options. A closed-suction drain was placed in all patients (retroperitoneal in OP and intraperitoneal in LP). Exclusion criteria included additional urinary tract anomalies, recurrent PUJO, vesicoureteral reflux, conversion to open surgery, and <1-year follow-up. Perioperative data, postoperative complications, and recovery metrics were recorded. Interleukin-6 (IL-6), IL-10, and lactate were measured at baseline, intraoperatively, immediately postoperatively, and at 48 h. Outcomes were compared using standard statistical tests, with P ≤ 0.05 considered significant.

RESULTS

Of 118 patients, 106 completed analysis (OP: 56, LP: 50). Age ranged from 6 months to 14 years (OP: 6.2 ± 2.8 years; LP: 6.5 ± 2.7 years). No anastomotic leaks or urinary extravasation occurred in either group. Baseline demographics were comparable. LP had longer operative times (136 ± 18 vs. 102 ± 14 min, P < 0.001) but reduced analgesic requirements and shorter analgesic duration (P < 0.001). Nonsteroidal anti-inflammatory drug use was required only in OP (14%, P = 0.005). OP showed higher incidence of flank bulges and longer IV fluid support (P = 0.005). Cytokine analysis revealed an early IL-6 surge in LP, attributed to pneumoperitoneum, but OP demonstrated higher IL-6 and IL-10 at 48 h, indicating sustained inflammation. Lactate elevations were transient and comparable. Renal functional outcomes were equivalent at 1 year.

CONCLUSIONS

LP offers comparable success with several perioperative benefits, including reduced pain, fewer wound-related complications, and attenuated late inflammatory response, particularly in experienced hands with adequate laparoscopic infrastructure, supporting its role as an effective alternative to OP in children.