Laparoscopic vs Open Extravesical Ureteral Reimplantation in Pediatric Population: A Single-Center Experience Pediatric Laparoscopic and Open Ureteral Reimplantation
Purpose: To evaluate the safety and efficacy of conventional laparoscopic vs open Lich-Gregoir ureteral reimplantation in pediatric vesicoureteral reflux.
Material and methods: A retrospective study was conducted in a tertiary care hospital. Patients with vesicoureteral reflux who underwent open or laparoscopic Lich-Gregoir ureteral reimplantation from 2013-2020 were included. The primary outcome was resolution of reflux. Complications and perioperative characteristics were evaluated. The outcomes between open and laparoscopic surgery were analyzed.
Results: A total of 110 patients and 150 ureters were included. The mean age was 4.5 years ± 3.4 and 73.6% were females. A total of 125 ureters (83.3%) underwent laparoscopic and 25 (16.6%) open Lich-Gregoir vesicoureteral reimplantation (5:1 Ratio). Resolution was reported in 112 (89.6%) for laparoscopy and 21 (84%) for open surgery (P = .42). Mean surgical time for laparoscopy and open surgery were 142.4 min ± 64.4 and 153 min ± 40, respectively (P =.29). Mean bleeding (9.5 mL ± 11.2 vs 29.6 mL ± 22.8) and length of hospital stay (2.4 days ± 2.3 vs 5.05 ± 3.1) were significantly higher with open surgery (P < .001). No significant difference in complications was reported between open surgery (32%) and laparoscopic approach (22.4%) (P = .305).
Conclusion: Conventional laparoscopic vesicoureteral reimplantation with the Lich-Gregoir technique has an acceptable success rate comparable with open surgery, with shorter hospital stay, less bleeding, and less need of transfusion.
- Vesicoureteral Reflux
- Vesicoureteral Reimplantation
How to Cite
Sargent MA. What is the normal prevalence of vesicoureteral reflux? Pediatr radiol. 2000;30:587-93.
Peters CA, Skoog SJ, Arant BS, et al. Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol 2010;184:1134-44
Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128:595-610.
Tokhmafshan F, Brophy PD, Gbadegesin RA, Gupta IR. Vesicoureteral reflux and the extracellular matrix connection. Pediatr nephrol. 2017;32 565–76.
Baek M, Kim KD. Current surgical management of vesicoureteral reflux. Korean J Urol. 2013;54:732-37.
Radmayr C, Bogaert G, Dogan HS, et al. Guidelines on paediatric urology. European Association of Urology. 2020:67-9.
Elder JS, Peters CA, Arant BS, et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol. 1997;157:1846–51.
Sung J, Skoog S. Surgical management of vesicoureteral reflux in children. Pediatr Nephrol. 2012;27:551-61.
Bayne AP, Shoss JM, Starke NR, Cisek LJ. Single-center experience with pediatric laparoscopic extravesical reimplantation: safe and effective in simple and complex anatomy. J Laparoendosc Adv Surg Tech 2012;22:102-6.
Kurtz MP, Leow JJ, Varda BK, et al. The decline of the open ureteral reimplant in the United States: national data from 2003 to 2013. Urology. 2017; 100:193-7.
Casale P, Patel RP, Kolon TF. Nerve sparing robotic extravesical ureteral reimplantation. J Urol 2008;179:1987.
Clavien PA, Barkun J, De Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:1987-90.
Lopez M, Varlet F. Laparoscopic extravesical transperitoneal approach following the Lich-Gregoir technique in the treatment of vesicoureteral reflux in children. J Pediatr Urol. 2010;45:806-10.
Roshani H, Dabhoiwala NF, Verbeek FJ, Kurth KH, Lamers WH. Anatomy of ureterovesical junction and distal ureter studied by endoluminal ultrasonography in vitro. J Urol. 1999;161:1614-19.
Tanagho EA, Pugh RC. The anatomy of the ureterovesical junction. Br J Urol. 1963;35:151-65.
Paquin AJ. Ureterovesical anastomosis: the description and evaluation of a technique. J Urol. 1959;82:573-83.
Riedmiller H, Gerharz EW. Antireflux surgery: Lich‐Gregoir extravesical ureteric tunnelling. BJUI. 2008;101:1467-82.
Kirsch AJ, Arlen AM. Evolving surgical management of pediatric vesicoureteral reflux: is open ureteral reimplantation still the ‘Gold Standard’?. International braz J Urol. 2020;46:314-21.
Tam PK. Laparoscopic surgery in children. Arch Dis Child. 2000;82(3):240-3.
Bustangi N, Kallas Chemaly A, Scalabre A, et al. Extravesical Ureteral Reimplantation Following Lich-Gregoir Technique for the Correction of Vesico-Ureteral Reflux Retrospective Comparative Study Open vs. Laparoscopy. Front Pediatr. 2018;6:388.
Farina A, Esposito C, Escolino M, Lopez M, Settimi A, Varlet F. Laparoscopic extravesical ureteral reimplantation (LEVUR): a systematic review. Transl Pediatr. 2016;5:291-4.
Riquelme M, Lopez M, Landa S, et al. Laparoscopic extravesical ureteral reimplantation (LEVUR): a multicenter experience with 95 cases. Eur J Pediatr Surg. 2013;23:143-7.
Pérez-Etchepare E, Varlet F, López M. Laparoscopic extravesical ureteral reimplantation following Lich-Gregoire technique. Medium-term prospective study. Cir Pediatr. 2014;2:74-7.
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