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Paper Information

Title: 

LAPAROSCOPIC DETRUSORORRAPHY IN CHILDREN WITH VESICO- URETERAL REFLUX

Type: PAPER
Author(s): SIMFOROOSH N.,SHADPOUR P.,KHEZRI F.*
 
 *
 
Name of Seminar: CONGREH ANJOMAN UROLOGY IRAN
Type of Seminar:  CONGRESS
Sponsor:  ANJOMAN OROLOGY
Date:  2005Volume 8
 
 
Abstract: 

UROLOGY NEPHROLOGY RESEARCH CENTER, SHAHID LABBAFI NEJAD HOSPITAL, SHAHID BEHESHTI UNIVERSITY OF MEDICAL SCIENCE
INTRODUCTION AND OBJECTIVE: NUMEROUS REPORTS HAVE ATTESTED TO THE EFFICACY OF ANTIREFLUX SURGERY BY LAPAROSCOPIC APPROASH IN ANIMAL MODELS. VERY FEW CLINICAL STUDISE HAVE ALSO APPEARED IN THE LITERATURE. HEREIN, WE PRESENT OUR ENCOURAGING RESULTS WITH DUE FOLLOW UP.
METHODS: 24 CHILDREN (AGED 1.5 TO 12 YEARS, WERE TREATED FOR SYMPTOMATIC ANATOMICAL REFLUX BY LICH-GREGOIR DETRUSORORRHAPHY, VIA TRANSPERITONEAL LAPAROSCOPY.31 REFLUXING UNITS WERE TREATED ALTOGETHER. A TUNNEL AVERAGING 2.5 CM LONG WAS CREATED BY FREE-HAND SUTURING, USING 2-0 ABSORBABLEMATERIAL. NO CATHETER OR DRAIN WASPLACED IN ANY BUT 6 CASES. THE PATIENTS HAVE BEEN FOLLOWEDVFOR 3-24 MONTHS (MEAN5.7) WITH SONOGRAPHY, URINE CULTURE, AND CYSTOGRAHPY.
RESULTS: 96.7% SUCCESS WAS GAINED IN PRIMARY REFLUX.OPERATIVE AND HOSPITALIZATION TIMES AVERAGED 113 MINUTES, AND 1.8 DAYS RESPECTIVELY. ALL PATIENTS HAVE SO FAR MAINTAINED STERILE URINE OFF ANTIBIOTICS AFTER THE DOCUMENTED RESOLUTION OR REFLUX.
IRRITATIVE SYMPTOMS AND HEMATURIA DID NOT OCCUR. NO PATIENT EXPERIENCED ANY INTER OPERATIVE COMPLICATION. ONE PATIENT REPORTED HESITANCY & INTERMITTENCY BUT VOIDS TO COMPLETION WITH NORMAL FLOW IN FOLLOW UP STUDIES. TWO OMENTAL PROTRUSIONS UPON DRAIN REMOVAL WERE TREATED LOCALLY. THE PROCEDURE WAS EPUALLY EFFECTIVE IN THOSE FAILING PREVIOUS ANTIREFLUX TREATMENT.
CONCLUSIONS: THE MERITS OF EXTRAVESICAL LAPAROSCOPIC ANTIREFLUX SURGERY ARE OBVIOUS IN TREM OF COSMESIS, SHORTER HOSPITAL STAY, AND LESS MORBIDITY. SURGICAL RESULTS ARE DURABLE, AND THE POSSIBILITY FOR MINIMIZING DAMAGE TO BLADDER INNERVATION BY LIMITED RETROVESICAL DISSECTION IS BRONE OUT BY THIS LESS INVASIVE METHOD. CLEARLY, WE HAVE NOT ENCOUNTERED SECONDARY VOIDING DYSFUNCTION IN OUR PATIENTS THUS FAR.

 
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