Is open pyeloplasty still a practical option for pediatric patients in resource-limited settings compared to laparoscopic and robotic approaches?

Abstract Purpose: To compare open pyeloplasty (OP) to laparoscopic (LP) and robotic pyeloplasty (RP) for pelviureteric junction obstruction in children in the subcontinent. Methods: A total of 168 patients (56 each) were randomized to receive OP, LP, or RP, respectively. Results: The operative time for the RP was significantly higher (P<0.001) compared to LP and open OP. The length of stay (LOS) for RP and LP was substantially lower (P<0.001) compared to the OP, with average stays of 2.8±1.5 days, 3.1±1.2 days, and 6.4±8.1 days, respectively. In the RP group, 53 participants (98.1%) exhibited non-obstructed drainage patterns post-operatively, compared to 52 (92.8%) in the LP group and 50 (89.3%) in the OP group (P=0.363). Only, 1(1.8%) patient in RP, 2(3.6%) in LP and 3(5.3%) in OP group exhibited obstructed drainage on dynamic nuclear scan. Grade II complications occurred in 7 patients in the RP cohort, 9 patients in LP and in 10 patients in the OP cohort. Higher-grade complications (Clavien Grade 3 and 4) were significantly more common in the OP group (9.0% vs 2% and 4%), P<0.001). Conclusion: OP demonstrates a similar success rate to LP and RP, establishing it as a viable surgical alternative for managing PUJO in paediatric patients.