2008, Number 3
Acta Pediatr Mex 2008; 29 (3)
Extravesical laparoscopic approach for vesicoureteral reflux
Riquelme-Heras M, Aranda-Gracia A, Rodríguez-Ramos C, Riquelme-Quintero M, Macías M
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Laparoscopy may have a place in the treatment of VUR, as previously reported in some small series without impact on current management. In this study we present the results of laparoscopic extravesical transperitoneal treatment on 41 units of VUR. Material and methods:
Between January 2001 and December 2007, 34 children (41 units) with primary VUR were treated with extravesical reimplantation (Lich-Gregoir technique) with a transperitoneal laparoscopic approach. Twenty-seven patients had unilateral VUR and seven had bilateral VUR. Four patients had double total collector system associated to reflux without ureterocele. Patients average age was 48. 2 months (range 12-62 months), 27 (80%) female and 7 male (20%). Results:
The average surgical time was 110 minutes in unilateral and 180 in bilateral VUR. All procedures were successfully completed laparsorcopically and the reflux was corrected in all except in one patient with grade III VUR who changed to grade I. We had 4 mucosalperforations, 3 of them without leakage, one had a urinoma as the result of early urinary catheter removal by the patient. Maximal hospital stay was 72 hours. After 15 to 49 months follow-up only one patient had a urinary tract infection. Conclusion:
This study shows that laprasocopic extravesical transpseritoneal reimplantation for vesicoureteral reflux is a safe and successful procedure, with less postoperative complaints, even in bilateral simultaneous and duplex ureters, with similar success rate, as with open surgery; a considerably shorter hospital postoperative stay, and earlier discharge. Mucosal perforation was treated maintaining a Foley catheter for 3 or 4 days.
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