Can modified lich-gregoir ureteroneocystostomy be able to performed as an outpatient for unilateral and bilateral vesicoureteral reflux treatment

Purpose: We report our experience with a Lich-Gregoir reimplantation (LGR) technique that included fixation of the ureter during detrusorraphy to preserve the integrity of the newly created submucosal tunnel, performed as an outpatient anti-reflux procedure. Methods: Fourty-five children (mean age: 8.2 years) with primary VUR underwent LGR between 2004 and 2009. Ten had bilateral VUR, 2 had ureteral duplication, 3 had megaureter, and 10 had previous subureteric injections. Through a Pfannenstiel incision the ipsilateral ureter was mobilized up to the ureterovesical junction without disturbing ureterotrigonal integrity. A 3–5 cm detrusorotomy was extended from the ureterovesical junction towards the umbilicus, the ureter was placed on the mucosa, and detrusorraphy was performed with a loosely running 3/4-0 polyglactin suture that passed through the detrusor on one side of the incision, taking a 1–2 mm "bite" of the ureteral adventitia, and detrusor on the other side. Postoperative ultrasonograms and voiding cystograms (VCUG) were obtained at 1 and 3 months, respectively. Children were then followed up for clinical symptoms of urinary tract infection with annual ultrasonograms. Results: The mean operative time was 58 min. Eighty-one percent of the children were treated as outpatients. Transient voiding difficulties occurred in 2 children with a bilateral procedure. Reflux was cured in 53 ureters (96%) with a mean follow-up of 30 months (range: 6–60). Ipsilateral obstruction was not evident during ultrasound surveillance. Conclusions: LGR is an outpatient procedure with a high success rate and a low morbidity. Integrity of the newly created submucosal tunnel is important for long-term success.