Application of abdominal sequential suspension in Laparoscopic Lich-Gregoir procedure for primary vesicoureteral reflux in children

Abstract

Objective To explore the safety and efficacy of abdominal sequential suspension in laparoscopic Lich-Gregoir procedure in children with primary vesicoureteral reflux (VUR). Methods From April 2017 to April 2018, clinical data were retrospectively analyzed for 14 children with primary VUR undergoing laparoscopic extravesical reimplantation (Lich-Gregoir technique). Results All children were hospitalized for recurrent urinary tract infection. There were 5 boys and 11 girls with a mean age of 36(9-72) months. The involved side was left (n=6) and right (n=8). Grades Ⅲ (n=3) and Ⅳ/Ⅴ (n=11) of VUR were confirmed by voiding cystourethrography (VCUG). Renal scars were assessed by dimercaptosuccinic acid (DMSA) scan. All laparoscopic Lich-Gregoir operations were successful. The average operative duration was 45(40-62) min and the mean intraoperative blood loss 3.5(2-8) ml. The disappearance of VUR was confirmed by VCUG in all children at 3 months postoperatively, except one with grade I. No reflux occurred on contrast-enhanced ultrasonography at 6 months postoperatively and VCUG at 9 months postoperatively. There was no recent renal scarring or urinary tract infections since then. Conclusions During laparoscopic Lich-Gregoir operation, abdominal sequential suspension can effectively expose surgical field and shorten the operative duration of cutting bladder muscle layer and embedding ureter. Key words: Laparoscopes; Vesicoureteral reflux; Lich-Gergoir; Sequential suspension