Laparoscopic Lich - Gregoir ureteroneocystostomy versus open surgery: Are there benefits from the minimally invasive procedure?

IF 2 3区 医学 Q2 PEDIATRICS
Bárbara María Yolanda Rivera Pereira, Sergio Landa Juárez, Horacio Márquez González
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引用次数: 0

Abstract

Background: The optimal treatment of vesicoureteral reflux is controversial. When patients need surgery, the gold standard is open vesicoureteral reimplantation. Despite the more frequent use of laparoscopy when managing vesicoureteral reflux, we have found scarce comparative studies comparing the open versus the laparoscopic Lich-Gregoir reimplantation.

Objective: The aim of this study is to compare the open Lich-Gregoir reimplantation technique versus the laparoscopic approach, in patients with primary vesicoureteral reflux in terms of complications and the procedure´s success, to document the benefits of minimal invasion.

Study design: This is a cross-sectional retrospective study of a single Institution, in which we collected the information of pediatric patients with primary vesicoureteral reflux from their clinical charts, in whom either an open or laparoscopic reimplantation following the Lich- Gregoir technique was performed, between January 1, 2013, and December 31, 2017. Patients with incomplete records were excluded. This was a non-probabilistic, consecutive case sample. The Chi-square test or Mann-Whitney´s U were used, as appropriate, to establish between-group differences.

Results: Sixty-eight patients were included, 27 in the open Lich-Gregoir group (OLG), and 41 in the laparoscopic Lich- Gregoir group (LLG). We found no statistical differences in operative times and mean hospital stay. Post-operative complications in the OLG versus the LLG group were similar. The open procedure was successful in 85.2 % and in 90.2 % laparoscopic cases, with no statistically significant difference between groups.

Discussion: We found no statistically significant differences between an open and a laparoscopic approach. The percentage of success was below the expected, this could be result of the large percentage of patients with high-grade reflux and the patients' complex anatomy in both groups. Our study is limited by the small number of patients and by its retrospective design.

Conclusions: The laparoscopic approach with the Lich-Gregoir technique yields similar results to the open technique. However, in this study, we were unable to demonstrate any additional benefits from the laparoscopic approach.

腹腔镜 Lich - Gregoir 输尿管膀胱造口术与开放手术:微创手术有好处吗?
背景:膀胱输尿管反流的最佳治疗方法尚存争议。当患者需要手术时,金标准是开腹膀胱输尿管再植术。尽管在治疗膀胱输尿管反流时腹腔镜的使用越来越频繁,但我们发现很少有比较研究对开放式和腹腔镜 Lich-Gregoir 再植术进行比较:本研究的目的是比较原发性膀胱输尿管反流患者中开放式 Lich-Gregoir 再植术与腹腔镜方法在并发症和手术成功率方面的差异,以记录微创的益处:这是一项在一家医疗机构进行的横断面回顾性研究,我们从儿科原发性膀胱输尿管反流患者的临床病历中收集了2013年1月1日至2017年12月31日期间,采用Lich- Gregoir技术进行开腹或腹腔镜再植术的患者信息。记录不完整的患者被排除在外。这是一个非概率性的连续病例样本。酌情使用卡方检验或曼-惠特尼U检验来确定组间差异:共纳入 68 例患者,其中 27 例为开腹 Lich-Gregoir 组(OLG),41 例为腹腔镜 Lich-Gregoir 组(LLG)。我们发现手术时间和平均住院时间没有统计学差异。开腹手术组和腹腔镜 LLG 组的术后并发症相似。开腹手术成功率为 85.2%,腹腔镜手术成功率为 90.2%,组间差异无统计学意义:讨论:我们发现开腹手术和腹腔镜手术在统计学上没有明显差异。成功率低于预期,这可能是由于两组患者中高度反流患者的比例都很高,而且患者的解剖结构都很复杂。我们的研究受到了患者人数少和回顾性设计的限制:结论:采用Lich-Gregoir技术的腹腔镜方法与开腹技术的效果相似。结论:采用Lich-Gregoir技术的腹腔镜手术与开腹手术效果相似,但在本研究中,我们无法证明腹腔镜手术能带来更多益处。
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来源期刊
Journal of Pediatric Urology
Journal of Pediatric Urology PEDIATRICS-UROLOGY & NEPHROLOGY
CiteScore
3.70
自引率
15.00%
发文量
330
审稿时长
4-8 weeks
期刊介绍: The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review. It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty. It publishes regular reviews of pediatric urological articles appearing in other journals. It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty. It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.
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