Retroperitoneal vs. Transperitoneal Laparoscopic Pyelolithotomy; a single surgeon’s experience

Objective: To compare the outcomes of transperitoneal and retroperitoneal laparoscopic pyelolithotomy procedures. Methods: A total of 104 consecutive laparoscopic pyelolithotomy surgeries performed by a single surgeon on patients with staghorn or renal pelvic calculi larger than 20 mm were evaluated. Intraoperative and postoperative clinical parameters from two groups, transperitoneal (TLPL) (N=55) and retroperitoneal (RLPL) (N=49), were compared. The surgeon performed TLPL for the first five years and then switched to the RLPL approach for the next five years. Results: There were no significant differences in general demographic variables and stone size (26.55 vs 24.73 mm, P = 0.8). Operation time and change in serum creatinine levels did not significantly differ between the two approaches. However, patients who underwent TLPL had longer hospital stays than RLPL (3.23±1.21 vs 2.36±1.10 days, P=0.0001). Prolonged hospitalization of more than three days occurred in 30.9% of the TLPL group compared to 8.2% for the RLPL group (P=0.004). Additionally, TLPL was associated with a greater drop in hemoglobin levels (1.53 ±1.04 vs 1.17±0.68, P=0.04), higher rates of postoperative fever (12.7% vs 0.0%, P=0.01), and more major complications (Clavien classification grade >3) (10.9% in TLPL vs 2% in RLPL, P=0.07). Conclusions: The retroperitoneal approach in pyelolithotomy for large renal pelvic stones resulted in fewer postoperative fevers, reduced hemoglobin drops, and shorter hospital stays than the transperitoneal approach. However, the stone-free rates were similar for both groups.