Laparoscopic versus open pyelolithotomy: our experience of 40 patients

Chetna Choudhary, Abhinav Jauhari


Background: The development of minimally invasive surgical techniques for the treatment of patients suffering from urinary lithiasis has been greatly dependent on technologic advances in the fields of fiberoptic, radiographic imaging, and lithotripsy (shockwave, ultrasonic, electrohydraulic, and laser). The objective of this study was to compare laparoscopic with open pyelolithotomy in relation to various indices and to ascertain whether laparoscopic surgery has superseded open surgery in modern era.

Methods: The study was conducted in Department of Surgery, GSVM Medical College and associated Hospital, Kanpur, Lucknow, India from January 2012 to September 2013. 40 patients who were diagnosed with renal pelvic stones, between the age group of 6-70 years were included in this study. Patients were assigned to either laparoscopy group or open group by a computer generated random number. In present study, all the patients in the laparoscopy group were operated by retroperitoneal approach.

Results: The male: female ratio was 2:1. The mean pain score was significantly less in laparoscopic group. Drain removal was done earlier in laparoscopic group. The patient in laparoscopic group stayed less as compared open groups. Of the total patients, who underwent surgery 6 sustained surgical complications in open group and only 1 in laparoscopic group. The patients who had undergone laparoscopic surgery returned to work earlier than those with open.

Conclusions: Patients operated by laparoscopic surgery shown a better post-operative recovery course, complaints of less pain and thus required less analgesia, returned to normal routine activity earlier, intra-abdominal drain was removed at a much earlier period as compared to open group patient, this not only reduced morbidity but also because of this patient could be discharged earlier. The complication rates were more in the open group as compared to laparoscopic group in terms of surgical site infection, urine leakage and post-operative fever. Patient satisfaction with cosmesis was more in laparoscopic group as compared to open group (as assessed by visual analogue score).


Laparoscopic treatment, Open approach, Renal pelvic stones, Retroperitoneal approach

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Johnson CM, Wilson DM, O’ Fallon WM, Malek RS, Kurland LT. Renal stone epidemiology: A 25-year study in Rochester, Minnesota Kidney Int. 1979;16(5):624-31.

Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curham GC. Time trends in reported prevalence of kidney stones in United States: 1976-1994. Kidney Int. 2003;63(5):1817-23.

Soucie JM, Thun MJ, Coates RJ, Mc Clellan W, Austin H. Demographic and geographic variability of kidney stones in United States. Kidney Int. 1994;46:893-9.

Maalouf NM, Cameron MA, Moe OW, Shakhace K. Novel insight into the pathogenesis of uric acid nephrolithiasis. Curr Opin Nephrol Hypertens. 2004;13:181-9.

Al- Hunayan A, Khalil M, Hascabo M, Hanafi A, Abdul Halim H. Management of solitary renal pelvic stones: Laparoscopic retroperitoneal pyelolithotomy versus percutaneous nephrolithotomy. J Endourol. 2011;25(6):975-8.

Keeley FX, Gialis I, Pillai M, Christofos M, Tolley DA. Laparoscopic ureterolithotomy: The Edinburgh experience. JU Tnt. 1999;(84):765-9.

Demirci D, Gulmez I, Ekmekcioglu O. Retroperitoneoscopic ureterolithotomy for the treatment of ureteral calculi. Urol Mt. 2004;(73):234-7.

Kramer BA, Lara Hammond L, Schwartz BF. Laparoscopic pyelolithotomy: indications and technique. J Endourol. 2007;21:860-1.

Chander J, Gupta N, Lal P, Lal P, Ramteke VK Retroperitoneal laparoscopic pyelolithotomy versus extra corporeal shock-wave lithotripsy for management of renal stones. J Minim Access Surg. 2010;6(4):106-10.

Gill IS, Grunde MT, Munch LC. Access technique for retroperitoneoscopy. J Urol. 1996;156:1120-4.

Fahlenkamp D, Rassweiler J, Fornara P, Frede T, Loening SA. Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 German centers. J Urol. 1999;162(3):765-71.

Sinha R, Sharma N. Retroperitoneal laparoscopic Management of Urolithiasis. J Laparoendosc Adv Surg Tech. 1992;7:95-8.

Goel A, Hemal AK. Evaluation of role of retroperitoneoscopic pyelolithotomy and its comparison with Percutaneous Nephrolithotripsy. Int Urol Nephrol. 2003;35:73-6.