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Laparoscopic anti-reflux plasty: experience of the University of São Paulo
Francisco T Dénes1, Anuar I Mitre, Marco A Arap
1School of Medicine, University of São Paulo, São Paulo, Brazil. ftdenes@terra.com.br
Insights
Laparoscopic Gregoir-Lich anti-reflux plasty (LGLP) offers a minimally invasive treatment for vesicoureteric reflux (VUR) in children and adults. This technique demonstrates a high success rate and is a viable alternative to open surgery.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Pediatric Surgery
Background:
- Vesicoureteric reflux (VUR) is a common cause of urinary tract infections in children, often diagnosed less frequently in adults.
- Established open anti-reflux plasty techniques include Politano-Leadbetter, Cohen, and Gregoir-Lich.
- The Gregoir-Lich technique is a preferred open surgical approach for VUR.
Purpose of the Study:
- To evaluate the feasibility and outcomes of laparoscopic Gregoir-Lich anti-reflux plasty (LGLP) in pediatric and adult patients.
- To assess the success rate and complication profile of LGLP for VUR treatment.
- To compare LGLP outcomes with established open surgical procedures.
Main Methods:
- Laparoscopic Gregoir-Lich anti-reflux plasty (LGLP) was performed on 15 patients (7 adults, 8 children) for VUR treatment.
- Data collected prospectively included patient demographics, VUR grade, operative details, complications, and follow-up outcomes.
- Bilateral VUR was addressed in the same procedure for 9 patients.
Main Results:
- A total of 23 ureteral units were treated, with VUR grades ranging from I to IV.
- Two children had prior failed endoscopic anti-reflux procedures.
- A 90% success rate was observed, with 19 out of 21 ureteral units showing no VUR post-operatively. Two laparoscopic-corrected mucosal perforations occurred.
Conclusions:
- Laparoscopic Gregoir-Lich anti-reflux plasty (LGLP) is a feasible and minimally invasive option for VUR treatment.
- LGLP successfully replicates the outcomes of the open Gregoir-Lich procedure.
- The technique achieves an excellent success rate without associated bladder dysfunction, even in bilateral cases.
Objectives:
Vesicoureteric reflux (VUR) is a common cause of urinary tract infections in children, being less commonly diagnosed in adults. Several anti-reflux plasties have been used successfully for the treatment of such condition, such as Politano-Leadbetter, Cohen and Gregoir-Lich techniques, the latter being our preferred approach in open procedures. Here we describe our experience with laparoscopic Gregoir-Lich anti-reflux plasty (LGLP) in children and adults.
Methods:
The LGLP was used for the treatment of VUR in 15 patients (7 adults and 8 children). Four adults and 5 children had bilateral disease and both sides were treated at the same procedure. Data was collected prospectively and we analysed age at treatment, laterality, degree of VUR, previous anti-reflux procedures, operative time, number of detrusor stitches used in each side, intra-operative and post-operative complications, success rate and follow-up.
Results:
A total of 23 ureteral units were treated. VUR was graded as I in one unit, II in 4 units, III in 10 units, IV in 7 units and 1 unit was not classified, as it was diagnosed by radioisotopic cystography. Two children had failed previous endoscopic procedures. There were no open conversions. Two muccosal perforations occurred during the procedure and were successfully treated laparoscopically. Nineteen out of 21 ureteral units (90%) presented no VUR at the cystographic control, and no bladder dysfunction was identified on follow-up.
Conclusions:
The LGLP is a feasible, minimally invasive alternative for VUR that reproduces the open procedure. It has an excelent success rate and is not associated to bladder disfunction, even in bilateral procedures.
