About 3% of primary pyeloplasties may require a re-do pyeloplasty for recurrent uretero
pelvic junction obstruction (UPJO) making it an uncommon operation even in large volume
centers. In this MA we have compared the outcomes of open (OP), laparoscopic (LP)
and robot assisted LP (RALP) approaches in managing recurrent UPJO.
Pubmed/Index medicus etc. were searched for re-do pyeloplasty (Open OR Laparoscopic
OR Robot-assisted) AND (Redo OR Reoperative OR failed) AND (child OR pediatric OR
paediatric), for articles published between 2001 and 2021. Duplicate publications
were identified and removed. Articles with grossly incomplete data and errors in reporting
were excluded, as were articles reporting <5 cases. The systematic review was carried
out according to PRISMA guidelines and meta-analysis of proportions was carried out
using MetaXL 5.3.
A total of 18 articles on re-do pyeloplasty were included in the analysis. In total,
there were 87, 77 and 123 redo pyeloplasties in OP, LP and RALP groups respectively.
The I2 statistics for OP, LP and RALP showed low heterogeneity with I2 of 24%, 0%
and 20% respectively. LFK index was 0.88, 0.30 and 1.62 for OP, LP and RALP respectively,
suggesting no or minor publication bias. The overall success rates of OP, LP and RALP
re-do pyeloplasty were 93.1% (95% CI 86–98), 92.1% (95% CI 83–96) and 89.4% (95% CI
83–96) respectively (summary table). The success rate between the techniques was not
significantly different, with p values (x2) of 1 (OP vs LP), 0.5 (OP vs RALP) and 0.6 (LP vs RALP). Overall, redo RALP took
significantly longer time than redo LP (p < 0.001, Fisher's). Overall, RALP had significantly
shorter hospital stay than LP (p < 0.001) and LP had significantly shorter hospital
stay than OP (p < 0.001). The complication rate was 9% in OP and LP and 16% in RALP,
the difference being not statistically significant (p value 1, 0.26 and 0.27 for OP
vs LP, OP vs RALP and LP vs RALP respectively, x2).
In conclusion MIS techniques (LP and RALP) seem to be good alternatives to OP for
redo pyeloplasty in children, with comparable success and complications. Redo RALP
had longer duration of surgery but shorter hospital stay than redo LP. With comparable
success & complication rate between RALP and LP, this MA could not favor one over
the other for redo pyeloplasty.