Krishanu Das*, George P Abraham, Krishnamohan Ramaswami, Datson George P, Jisha J Abraham, Thomas Thachill and Thampan OS
Department of Urology, Lakeshore Hospital, IndiaFulltext PDF
Objective: To assess the efficacy of laparoscopic Lich-Gregoir antireflux surgery in management of Grade III-V vesicoureteric reflux.Methods: Patients with bothersome urinary infection and high grade vesicoureteric reflux (grades III-V) were recruited for the procedure. All patients were worked up in detail. Pre-procedure cystoscopy was performed with placement of ureteral stent and a perurethral catheter. Ureteric reimplantation was performed following Lich-Gregoir principle. Voiding cystogram and ultrasound were evaluated 6 monthly.Results: From August 2009 till June 2012, 36 patients (68 renal units — 30 bilateral, 4 unilateral and 2 common sheath reimplantations) underwent laparoscopic antireflux surgery. Preoperative reflux grades were 32 Grade III, 24 Grade IV and Grade V in 12. Mean operation duration was 103.33 min for unilateral and 154.09 min for bilateral antireflux procedure. A difference in operation duration between male and female children was perceived (115 min vs. 165 min, p<0.001). No major intraoperative events were encountered. Postoperatively 3 patients complained of vague abdominal pain. Mean hospital stay was 2.5 days. 3 patients complained of voiding dysfunction after catheter removal. 30 children (60 renal units) attended 3 year follow-up. Complete resolution of VUR was noted in 30 Grade III (100%), 21 Grade IV (95.45%) and 9 Grade V (75%) units. Overall reflux resolution rate was 93.75%.Conclusion: Laparoscopic Lich-Gregoir type of antireflux procedure offers satisfactory outcome in management of high grade VUR. Children with Grade V VUR may benefit from ureteral tapering prior to antireflux construction.
Vesico; Ureteric reflux; Laparoscopy; Antireflux surgery
Das K, Abraham GP, Ramaswami K, Datson George P, Abraham JJ, Thachill T, Thampan OS. Laparoscopic Lich Gregoir Extravesical Ureteric Reimplantation for Correction of High Grade Vesicoureteric Reflux- Short, Intermediate and Long Term Outcomes with Literature Review. Clin Surg. 2017; 2: 1456.