Outcomes afterPediatric Robot-AssistedLaparoscopicPyeloplasty: How Long Do We Need to Follow?
Andrew Lai, MD, MPH1, Rachel Shannon, MPH2, Ilina Rosoklija, MPH2, Emilie Johnson, MD, MPH2, Edward Gong, MD2, David I. Chu, MD, MSCE1, Bruce W. Lindgren, MD2.
1University of Illinois at Chicago, Chicago, IL, USA, 2Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Background Robot-assisted laparoscopic pyeloplasty (RALP) has been shown to be as safe and effective as open pyeloplasty in treating pediatric ureteropelvic junction obstruction (UPJO). Although reported RALP success rates are consistently high, this literature is limited to short-term outcomes and may not capture late recurrent obstructions. Furthermore, no standardized guidelines exist regarding the optimal follow-up duration after pyeloplasty, and the benefit of long-term imaging is not well defined. Previous studies have suggested that the minimum follow-up time for pediatric pyeloplasty should be 2-3 years to capture most recurrent obstructions, but RALP were either not included or were a minority of cases in these studies. We aim to describe the intermediate- and long-term success and clinical outcomes of pediatric patients undergoing RALP with the primary goal of determining optimal follow-up duration. Methods We retrospectively reviewed all patients ages ≤21 years old who underwent primary RALP from 7/2007 through 12/2019. The primary outcome was surgical success, defined as radiographic improvement of hydronephrosis without need for reoperation. Secondary outcomes were time to reoperation and 90-day complication rate.
Results A total of 356 patients underwent primary repair of UPJO during the study period (Table 1: Patient Characteristics). Radiographic improvement at latest follow-up was seen in 308/326 (94.5%). Thirty-nine patients were lost to follow-up without imaging. Ten of 365 patients (2.8%) underwent reoperation: 6 were identified within 1 year of RALP, 3 between 1-2 years, and 1 at 2-3 years after RALP. Over one third (122/356, 34.2%) have had >3 years of follow-up, none of whom have developed evidence of recurrent obstruction requiring reoperation. The median time to reoperation was 13.0 months (IQR 9.3-21.7). The 90-day complication rate was 5.6%. There were 3 Clavien-Dindo Class I, 2 Class II, 1 Class IIIa, and 14 (3.9%) Class IIIb complications. Of the 14 short-term complications, 6 (43%) were stent-related.
Conclusions This largest single-institution series of patients undergoing RALP confirms safety and surgical effectiveness data from prior studies. Data also indicate that ≥3 years of follow-up is needed to identify surgical failures and confirm that reoperations beyond 3 years post-RALP are rare.
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