OPTIMIZATION OF ENDOSURGICAL TECHNIQUE IN URETERONEOCYSTOSTOMY

Resume. Aim. To improve the outcomes of surgical treatment of primary obstructive megaureter in young children by optimizing the technique of laparoscopic extravesical ureteral reimplantation. Materials and methods. A retrospective-prospective analysis of the surgical treatment results of 67 patients with primary obstructive megaureter was conducted. The control group (n=39) included children who underwent traditional open ureteral reimplantation; the main group (n=28) consisted of patients who underwent laparoscopic extravesical reimplantation (Lich-Gregoir technique) with longitudinal remodeling and antegrade intraoperative stenting. Results. The mean operative time for laparoscopy was 138.5±22.4 min, which was longer than the open procedure — 84.3±11.2 min (p<0.05). However, avoiding wide cystotomy in the laparoscopic approach reduced the duration of urethral catheterization from 8.5±1.5 to 1.8±0.6 days (p<0.001) and decreased the rate of specific postoperative complications (Clavien-Dindo grades I-II) from 85.6% to 7%. The average postoperative hospital stay was reduced almost by half: from 12.6±1.8 to 6.4±1.1 days (p<0.01). Long-term functional outcomes were comparable in both groups. Conclusions. Laparoscopic extravesical Lich-Gregoir reimplantation with antegrade stenting is a highly effective and safe method for the surgical correction of megaureter in children. Keywords: megaureter, children, laparoscopy, ureteroneocystostomy, Lich-Gregoir, minimally invasive surgery, complications.

Hali tarjima qilinmagan