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Objective: To compare the outcomes of laparoscopic pyelolithotomy and open pyelolithotomy at a single center in terms of operative time, blood loss, intra- and post-operative complications, analgesia requirements, hospital stay, convalescence and cosmesis. Material and methods: This prospective randomized study was conducted in the Department of Surgery of the Government Medical College Srinagar between May 2008 and September 2010. Sixty patients underwent pyelolithotomy during this period, including both open pyelolithotomy (n=30) and laparoscopic retroperitoneal pyelolithotomy (n=30). All patients (age >14 yr) with large (>1.5 cm) renal pelvic stones who met the inclusion criteria were included in the study. The decision to perform open or laparoscopic pyelolithotomy was made randomly by a computer program. Results: The majority of our patients in both study groups were in the 21-40 yr age group. The mean operative time was significantly less (p<0.001) in the open group than in the laparoscopic group (74.83 min vs. 94.43 min). The mean blood loss was less in the laparoscopic group than in the open group (73 mL vs. 103 mL); however, this difference was not statistically significant. In the laparoscopic group, both the resumption of oral intake (10.33 hrs vs. 15.60 hrs) and the drain removal (2.7 days vs. 3 days) occurred earlier, although these differences were not significant. Intraoperative complications occurred more frequently in the laparoscopic group (16% versus 6.66%); however, all of the complications were minor and were managed intraoperatively in the same sitting. There was no statistically significant difference in the postoperative pain scores or analgesia requirements, and postoperative complications were only slightly more frequent in the laparoscopic group in our study. The mean hospital stay in the open group was 5.2 days, while the mean stay of the laparoscopic group was 3.8 days (p<0.03). Patients in the laparoscopic group returned to their routine activities significantly earlier (1.78 vs. 3.83 wks) than did patients in the open group (p<0.001). Conclusion: Laparoscopic retroperitoneal pyelolithotomy for upper urinary tract calculi is superior to open surgery because of the significantly reduced hospital stays and cosmetic outcomes of patients who underwent the laparoscopic surgery. Although the reductions of analgesia requirements and blood loss were not statistically significant in our study, the data still favored the laparoscopic procedure. Disadvantages of retroperitoneal laparoscopy include the decreased working space, the cost of equipment and the availability of a trained surgeon. [ABSTRACT FROM AUTHOR]