Laparoscopic Lich Gregoir Extravesical Ureteric Reimplantation for Correction of High Grade Vesicoureteric Reflux- Short, Intermediate and Long Term Outcomes with Literature Review

Krishanu Das, George P Abraham, Krishnamohan Ramaswami, Datson George P, Jisha J Abraham, Thomas Thachill and Thampan OS

Department of Urology, Lakeshore Hospital, India

^*Correspondance to: Krishanu Das 

 PDF  Full Text DOI: 10.25107/2474-1647.1456

Abstract

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.

Keywords

Vesico; Ureteric reflux; Laparoscopy; Antireflux surgery

Cite the article

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.