Laparoscopic Pediatric Pyeloplasty: Trends in Regions of the Russian Federation

Abstract

Introduction. The use of minimally invasive surgery of urteropelvic junction obstruction was started in the in the mid-90s of the last century. Replacement rates of open surgery and methods of the minimally invasive surgery are different in various countries. We analyzed the spread of minimally invasive technologies in some regions of the Russian Federation.Purpose of the study. To study the dynamics of replacement of open pyeloplasty with laparoscopic pyeloplasty in certain regions of the Russian FederationMaterial and methods. Available data included the annual number of laparoscopic and open pyeloplasties, patient age, complications, and medium-term results. Our analysis screened 1581 pyeloplasties, which were performed during 2004‒2018 in eight regions of the Russian Federation. The patients were separated into two groups according to age. There were 566 infants and 1015 older children. A total 908 (57.4%) laparoscopic pyeloplasty (LP) and 673 (42,6%) open pyeloplasty (OP) were performed. Of those patients who underwent laparoscopic pyeloplasty, 274 (48.4%) were infants, while 624 (61.5%) were older children. The rates of LP and OP use were then assessed according to year of surgery. A binary logistic regression model was used to evaluate the statistical significance of the rate of LP use over time, to predict postoperative complications and to compare the effectiveness of LP in comparison with OP.Results. The use of LP increased remarkably during the study period. In regions with 5 years of LP experience, LP utilization rate was significantly higher. The rate of LP in infants has been associated with increasing experience in the LP. A total, 70% of older children and 59% of infants were operated with LP in 8 regions in 2018.Conclusion. In some regions of the Russian Federation, the rate of LP is markedly increased and almost replaces open surgery. In regions where LP has been introduced over the past 5 years, the replacement rate is higher than in regions where LP was introduced before.