To compare the safety and efficacy of transperitoneal and retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction (UPJO).

Clinical data of patients aged ≥18 years who were diagnosed with UPJO and underwent laparoscopic pyeloplasty in the Second Hospital of Lanzhou University from January 2015 to June 2020 were collected. The patients were compared the perioperative indexes, the incidence of complications and the success rate of surgery between the two groups.

A total of 195 patients were included in this study, and the baseline difference between the two groups was not statistically significant. Comparison of perioperative indexes and recent complications showed that the duration of operation [190(150, 230) min vs 200(174, 260) min, P=0.030], the number of days of drainage tube indwention [5.0(3.0, 6.0) d vs 6.0(4.0, 8.0) d,P=0.005] and the number of days of postoperative hospitalization [6.0(5.0,7.0) d vs 8.0(5.0, 9.0) d, P=0.006] in the transperitoneal group were shorter than those in the retroperitoneal space group, the transfer opening rate in transperitoneal group was lower than that in retroperitoneal space group [3(3.2%) vs 10(12.5%), P=0.019]. There was no significant difference in intraoperative blood loss, postoperative special care time and fasting time between the two groups (P>0.05). There was no difference in the incidence of urinary leakage, urinary tract infection, intestinal obstruction, hypercapnia and other recent complications between the two groups (P>0.05). Results of long-term follow-up of patients showed that there were no significant difference between the two groups in calculus formation, ureteral stent displacement, overall complication rate and surgical success rate (P>0.05).

For those who have gained some experiences in laparoscopic surgery, compared with retroperitoneal laparoscopic pyeloplasty, transperitoneal laparoscopic pyeloplasty has shorter operation time, lower conversion rate, shorter duration of drainage tube retention and shorter postoperative hospital stay. The incidence of complications and surgical efficacy of the two approaches are similar.