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

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.