Preliminary application and efficacy evaluation of the modified Lich-Gregoir technique in the management of primary
Zaibing Ye1, Lingfei Wang1, Xingru Fu1
1Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Purpose:
To evaluate the clinical efficacy and safety of a modified Lich-Gregoir technique for treating primary obstructive megaureter (POM) in children.
Materials And Methods:
Between January 2023 and June 2024, a modified Lich-Gregoir procedure was performed on thirty-eight pediatric patients with POM at two medical centers, using either robot-assisted laparoscopic (RALUR) or laparoscopic ureteral reimplantation (LUR). The core procedural innovation involves creating a new ureteral orifice at the bladder dome, anastomosing the distal ureter to it, and embedding the ureter into the muscular layer of the bladder. Statistical analyses were conducted on several parameters, encompassing imaging features such as distal ureteric diameter and anteroposterior pelvic diameter. Perioperative safety was evaluated using metrics including operation time, estimated blood loss, and complication rates. Postoperative recovery was assessed through the duration of hematuria and the length of the postoperative hospital stay.
Results:
All procedures were performed successfully, with no conversions or intraoperative complications. The RALUR group exhibited a shorter intra-abdominal time and a briefer duration of gross hematuria than the LUR group. During follow-up, urinary tract infections were observed in one patient following RALUR and in three patients after LUR. At the six-month postoperative follow-up, both groups exhibited significant decreases in ureteral diameter and anteroposterior pelvic diameter. The procedures achieved a 100 % success rate, with no instances of recurrent obstruction.
Conclusion:
Our preliminary experience indicates that the modified Lich-Gregoir technique effectively alleviates POM-related ureteral dilation and hydronephrosis, yielding promising results.
Insights
The modified Lich-Gregoir technique offers a safe and effective treatment for pediatric primary obstructive megaureter (POM), successfully reducing ureteral dilation and hydronephrosis with a 100% success rate.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Ureteral Reconstruction
Background:
- Primary obstructive megaureter (POM) is a congenital condition requiring surgical intervention.
- Traditional surgical approaches may involve significant morbidity.
- A modified Lich-Gregoir technique presents a novel approach for POM treatment.
Purpose of the Study:
- To assess the clinical efficacy and safety of a modified Lich-Gregoir technique in pediatric patients with POM.
- To compare robot-assisted laparoscopic ureteral reimplantation (RALUR) with laparoscopic ureteral reimplantation (LUR).
Main Methods:
- A modified Lich-Gregoir procedure was performed on 38 pediatric patients with POM.
- Technique involved creating a new ureteral orifice at the bladder dome and embedding the ureter.
- Patients were treated using either RALUR or LUR.
Main Results:
- All procedures were successful with no intraoperative complications.
- RALUR showed shorter operative time and reduced hematuria duration compared to LUR.
- Significant reduction in ureteral diameter and anteroposterior pelvic diameter observed postoperatively.
- 100% success rate with no recurrent obstruction; low rates of urinary tract infections.
Conclusions:
- The modified Lich-Gregoir technique is effective in treating POM, alleviating ureteral dilation and hydronephrosis.
- This technique demonstrates promising outcomes and a high success rate in pediatric patients.
- Both RALUR and LUR approaches yielded favorable results with minimal complications.
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