Laparoscopic Lich-Gregoir procedure for bilateral primary vesicoureteral reflux in children

Abstract

Objective We reviewed the results of laparoscopic Lich-Gregoir procedure in children with bilateral primary vesicoureteral reflux(VUR). Methods Between September 2007 and September 2009, 4 children with bilateral primary VUR underwent laparoscopic extravesical reimplantation (Lich-Gregoir technique). The clinical data was retrospectively analyzed. Results All patients were referred to our clinic for recurrent urinary tract infection. The mean age of the patients was 6.5 years ( ranging from 5 to 8 years ), and there were 1 boy and 3 girls. Bilateral primary vesicoureteral reflux was confirmed by voiding cystourethrography (VCUG), including 2 sides with grade Ⅴ, 3 with grade Ⅳ and 3 with grade Ⅲ. Renal scars were assessed with dimercaptosuccinic acid (DMSA) scans.Four patients underwent transperitoneal laparoscopic Lich-Gregoir operations. All procedures were successfully completed laparoscopically. The mean operative time was 200 minutes ( ranging from 140 to 300 min). The blood loss was minimal. The mean hospital stay was 6 days (ranging from 5 to 7 days). The average follow-up period was 18.5 months ( ranging form 6 to 30 months). The disappearance of VUR was confirmed in all patients with VCUG 6 months post-operatively. There was no febrile urinary tract infections or new renal scarring post-operatively. There was transient urinary retention in 1 patient, but the symptom disappeared after catheterization for one week. Conclusions Laparoscopic transperitoneal Lich-Gregoir reimplantation for vesicoureteral reflux is a safe and effective approach. Key words: Laparoscopic surgical procedures; Vesicoureteral reflux; Eimplantation