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DOI: 10.1055/s-0029-1233496
© Georg Thieme Verlag KG Stuttgart · New York
Lich-Gregoir Ureteral Reimplantation with Fixation of Ureter during Detrusorraphy as a Reliable Outpatient Anti-reflux Procedure
Publication History
received May 14, 2009
accepted after revision June 30, 2009
Publication Date:
10 September 2009 (online)
Abstract
Purpose: We report our experience with a Lich-Gregoir reimplantation (LGR) technique that included fixation of the ureter during detrusorraphy to preserve the integrity of the newly created submucosal tunnel, performed as an outpatient anti-reflux procedure.
Methods: Ninety-seven children (mean age: 7.9 years) with primary VUR underwent LGR between 1995 and 2008. Twenty-one had bilateral VUR, 8 had ureteral duplication, 9 had megaureter, and 13 had previous subureteric injections. Through a Pfannenstiel incision the ipsilateral ureter was mobilized up to the ureterovesical junction without disturbing ureterotrigonal integrity. A 3–5 cm detrusorotomy was extended from the ureterovesical junction towards the umbilicus, the ureter was placed on the mucosa, and detrusorraphy was performed with a loosely running 3/4-0 polyglactin suture that passed through the detrusor on one side of the incision, taking a 1–2 mm “bite” of the ureteral adventitia, and detrusor on the other side. Postoperative ultrasonograms and voiding cystograms (VCUG) were obtained at 1 and 3 months, respectively. Children were then followed up for clinical symptoms of urinary tract infection with annual ultrasonograms.
Results: The mean operative time was 56 min. Eighty-one percent of the children were treated as outpatients. Transient voiding difficulties occurred in 2 children with a bilateral procedure. Reflux was cured in 116 ureters (98%) with a mean follow-up of 58 months (range: 6–128). Ipsilateral obstruction was not evident during ultrasound surveillance.
Conclusions: LGR is an outpatient procedure with a high success rate and a low morbidity. Integrity of the newly created submucosal tunnel is important for long-term success, which may be facilitated by our modified detrusorraphy technique.
Key words
vesicoureteral reflux - surgery - outpatients - technique
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Correspondence
Dr. Fikret Fatih Onol
Sakarya Training and Research Hospital
Urology
Korucuk campus
54290
Sakarya
Turkey
Phone: 90-5335141099
Fax: 90-2122307644
Email: ffonol@yahoo.com