Session Name: Kidney Technical
Session Date & Time: None. Available on demand.
*Purpose: In this study, we describe and compare the postoperative outcomes of our modified Lich-Gregoir ureteroneocystostomy (mLG), without DJ stent and with early bladder catheter removal, with the traditional technique.
*Methods: Data from 100 consecutive patients who underwent mLG with early (48 hours) bladder catheter removal between October 2018 and November 2019 were compared to a control group (LG) comprised by the last 165 consecutive patients who underwent traditional Lich-Gregoir technique with routine (4-5 days) bladder catheter removal until July 2017. The same surgeon performed all surgeries and follow up was 6 months after transplantation. Surgical complications were stratified in early, occurring during the first month, and late.Differently from the traditional LG technique, in which the bladder mucosa is completely separated from the muscular layer, in our mLG the detrusor muscle is dissected in order to preserve a thin layer of detrusor fibers over the mucosa. Subsequently, the vesicoureteric anastomosis is performed by 2 separate continuous sutures of polidioxanone 6.0 between the spatulated ureter and the mucosa coated with detrusor fibers. Finally, the upper muscle layer is then loosely approximated over the distal portion of the ureter using interrupted 3.0 polyglactin sutures in order to create a tunnel that will serve as an anti-reflux mechanism.
*Results: Patients in the mLG group were younger (37.4±13.7yo vs. 42±14.0yo, p=0.012) and had higher residual diuresis volume (911±753.8mL vs. 629±638.6mL, p=0.016). The incidence of diabetes was low and similar in both groups. There were no differences in chronic kidney disease etiology and time on dialysis was relatively short. Over 77% received a kidney from a living donor, and there were no differences in cold and warm ischemia time. There was a statistical difference in the distribution of the maintenance immunosuppressive regimen, with a lower proportion of patient receiving an mTOR inhibitor in the mLG group.After the transplant, it was observed that patients from the mLG group successfully underwent early indwelling Foley catheter removal (2.2±0.9d vs. 4.8±4.8d, p<0.001) and had a significantly lower hospital length of stay (6.5±5d vs. 7.1±6.2d, p=0.023), while also having lower rates of early surgical complication (3% vs. 17%, p=0.029). When analyzing specifically the occurrence of urinary leakages, we observed that in the mLG group there was only 1 case that resulted from necrosis of the entire ureter secondary to thrombosis of the graft’s lower polar renal artery, while in the LG group there were 5 cases directly related to the vesicoureteric anastomosis.
*Conclusions: The results of this study suggest that our modified Lich-Gregoir ureteroneocystostomy technique for kidney transplantation is a safe alternative to the traditional method, even with an early bladder catheter removal and without the use of DJ stents.
To cite this abstract in AMA style:Astolfi RH, Medina-Pestana J, Junior HTedescoSilva, Aguiar W. Detrusor Reinforced Lich-Gregoir Ureteroneocystostomy for Kidney Transplants Recipients: Comparative Analysis of the First 100 Cases [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/detrusor-reinforced-lich-gregoir-ureteroneocystostomy-for-kidney-transplants-recipients-comparative-analysis-of-the-first-100-cases/. Accessed June 11, 2021.
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