Laparoscopic pyeloplasty is currently recognized as the standard of care for pediatric ureteropelvic junction obstruction. However, the choice between laparoscopic transperitoneal (LT) and laparoscopic retroperitoneal (LR) approaches remains a subject of ongoing debate, as existing literature presents conflicting reports regarding operative efficiency and hospitalization duration. To compare the efficacy and safety of LT versus LR in pediatric patients and investigate sources of heterogeneity using meta-regression, a systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searching PubMed, Cochrane Library, and Google Scholar for all records published up to December 19, 2025. Data were synthesized using a random-effects meta-analysis. Meta-regression and restricted cubic spline analyses were employed to assess the influence of study design, country, and patient age on heterogeneity (I2>90%). Six comparative studies (one randomized controlled trial and five retrospective studies) were included. Pooled analysis showed no significant differences in success rates (risk ratio = 1.00; 95% confidence interval = 0.96-1.04), complications, or conversion rates. However, meta-regression revealed that study design significantly influenced operative time (p=0.035), with retrospective studies exaggerating time differences compared to randomized trials. Additionally, country of origin was the primary driver of hospital stay variation (p=0.013; R2 of approximately 70%). Exploratory restricted cubic spline analysis suggested a possible age-related inflection point for conversion risk at approximately 2.06 years; however, this finding should be considered hypothesis-generating because of the limited number of included studies. LT and LR demonstrate comparable safety and efficacy. Variability in operative time and hospitalization is largely driven by study design biases and geographic protocols rather than intrinsic technical differences. While both techniques are effective, anatomical constraints in infants under two years warrant careful consideration.
Suprabawati et al. (Sat,) studied this question.