Laparoscopic pyeloplasty in infants with ureteropelvic junction obstruction managed with the enhanced recovery after surgery approach: a single-center experience.

OBJECTIVE

To report our single-center experience of laparoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO) in infants managed with the Enhanced Recovery After Surgery (ERAS) approach.

METHODS

The clinical data of infants aged ≤ 12 months with UPJO who underwent laparoscopic pyeloplasty at our center from October 2018 to October 2023 and who were eligible for inclusion according to the inclusion and exclusion criteria were collected. General clinical, perioperative, and postoperative data were collected. All infants were managed with the ERAS approach. ERAS is a multidisciplinary perioperative approach designed to improve perioperative management and facilitate patient early recovery.

RESULTS

Overall, 37 patients were included. All surgeries were successfully completed without conversion to open surgery. The median age of the patients was 2 (1, 4.5) months. The median weight was 6.5 (5.25, 7.25) kg. The mean surgical duration was 251.3 ± 65.4 min, and the mean hemorrhage volume was 7.4 ± 5.3 mL. There were no intraoperative complications. The mean postoperative pain score was 0.24 ± 0.86, and the median urinary catheter removal time was 1 (1, 1) day. The mean postoperative hospital length of stay was 2.7 ± 2.3 days, and the mean overall hospital stay was 6.5 ± 3.5 days. The mean hospital cost was 31,515.2 ± 5,550.9 yuan. Postoperative complications were observed in 9 patients (24.3%), including one patient (2.7%) with intestinal obstruction (Clavien-Dindo classification grade I), four (10.8%) with febrile urinary tract infection (Clavien-Dindo classification grade II), and four (10.8%) with distal ureteral stricture. The median time to double J-tube extraction was 35 (32,66) days, the mean follow-up time was 33.6 (± 20.7) months, and the success rate was 100% (37 of 37 patients).

CONCLUSIONS

ERAS-managed laparoscopic pyeloplasty is safe and effective in infants with UPJO.