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Eur J Pediatr Surg 2024; 34(03): 245-252
DOI: 10.1055/s-0043-1764321
Original Article

Minimally Invasive versus Open Ureteral Reimplantation in Children: A Systematic Review and Meta-Analysis

Shaoguang Feng‡   *
1   Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
2   Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
,
Zhechen Yu‡   *
2   Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
,
Yicheng Yang‡   *
2   Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
,
Yunli Bi
3   Department of Pediatric Urology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
,
Jinjian Luo
4   Department of Pulmonary and Critical Care Medicine (PCCM), Anji County People's Hospital, Huzhou, Zhejiang, China
› Author Affiliations Funding This study was supported by Suzhou Key clinical disease diagnosis and treatment technology project (Grant number LCZX201718 to Y.B.).
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Abstract

Purpose We performed a systematic review and meta-analysis to compare the safety and efficacy of minimally invasive surgery (MIS) versus open ureteral reimplantation (OUR) in children.

Methods Literature searches were conducted to identify studies that compared MIS (laparoscopic ureteral reimplantation or robot-assisted laparoscopic ureteral replantation) and OUR in children. Parameters such as operative time, blood loss, length of hospital stay, success rate, postoperative urinary tract infection (UTI), urinary retention, postoperative hematuria, wound infection, and overall postoperative complications were pooled and compared by meta-analysis.

Results Among the 7,882 pediatric participants in the 14 studies, 852 received MIS, and 7,030 received OUR. When compared with the OUR, the MIS approach resulted in shorter hospital stays (I 2 = 99%, weighted mean difference [WMD] –2.82, 95% confidence interval [CI] –4.22 to –1.41; p < 0.001), less blood loss (I 2 = 100%, WMD –12.65, 95% CI –24.82 to –0.48; p = 0.04), and less wound infection (I 2 = 0%, odds ratio 0.23, 95% CI 0.06–0.78; p = 0.02). However, no significant difference was found in operative time and secondary outcomes such as postoperative UTI, urinary retention, postoperative hematuria, and overall postoperative complications.

Conclusion MIS is a safe, feasible, and effective surgical procedure in children when compared with OUR. Compared with OUR, MIS has a shorter hospital stay, less blood loss, and less wound infection. Furthermore, MIS is equivalent to OUR in terms of success rate and secondary outcomes such as postoperative UTI, urinary retention, postoperative hematuria, and overall postoperative complications. We conclude that MIS should be considered an acceptable option for pediatric ureteral reimplantation.

Keywords

laparoscopic surgery - robot-assisted laparoscopic surgery - open surgery - ureteral reimplantation - children - meta-analysis

Authors' Contributions

S.F. contributed to the conception and design of study and drafting the manuscript. Z.Y. contributed to the acquisition of data and drafting the manuscript. Y.Y. contributed to the acquisition of data, drafting the manuscript. Y.B. contributed to the conception and design of study, analysis and/or interpretation of data. J.L. contributed to the conception and design of study, analysis and/or interpretation of data, and drafting the manuscript.


* These authors contributed equally to the work and retain the first authorship.




Publication History

Received: 30 January 2023

Accepted: 31 January 2023

Article published online:
07 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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