Laparoscopic versus open ureterolithotomy a comparative study. Commentary

Objective:The aim of this study is to compare the transperitoneal laparoscopic ureterolithotomy versus conventional open surgery in cases of ureteric stones which failed to be treated endoscopically. Materials and Methods: In this study, the clinical results of 18 transperitoneal laparoscopic ureterolithotomies (TLU) are compared with 18 open ureterolithotomies (OU) for impacted or large stones of the upper and middle portion of the ureter that were unable to be disintegrated with extracorporeal shock wave lithotripsy (SWL) or endoscopically. In the analysis of the clinical data are included the operative time and the post-operative morbidity, length of analgesia needed, hospital stay and convalescence period. Results: All our laparoscopic procedures were accomplished successfully. The mean operation time was 130 min forTLU and 85 min for OU. Analgesic medication requirement per patient was 1 day forTLU and 4 days for OU while the postoperative hospital stay averaged 3 days forTLU and 8 days for OU and the time of convalescence was12 days forTLU and 22 days for OU. No patient required a blood transfusion and postoperative complications included urinary leak, subcutaneous hematoma, subcutaneous emphysema in theTLU group and wound cellulitis and urinary tact infections in the OU group. Conclusion: While most patients with ureteric calculi can be rendered stone-free with SWL and endourological procedures, open stone surgery continues to represent a reasonable alternative for a small segment of the urinary stone population. However, our results reveal distinct benefits ofTLU when compared to OU and thus laparoscopy instead of open surgery should be preferred.