L'intérêt de la technique de Lich Gregoir par voie laparoscopique dans le traitement du reflux vésico- urétéral primitif

Abstract

Title : The Value of the Laparoscopic Lich-Gregoir Technique in the Management of Primary Vesicoureteral Reflux in Children. Introduction : Primary vesicoureteral reflux (VUR) is a common congenital anomaly of the ureterovesical junction predisposing to recurrent urinary tract infections and reflux nephropathy. Laparoscopic extravesical ureteral reimplantation using the Lich-Gregoir technique is a validated minimally invasive alternative to open surgery. Objective : To evaluate the anatomical and functional outcomes of laparoscopic extravesical ureteral reimplantation using the Lich-Gregoir technique for primary VUR in children and compare our results with international series. Patients and Methods : Prospective study including 61 children (65 ureteral units) operated between 2019 and 2025. Mean age: 5.34 ± 2.48 years (1–12 years), female predominance (sex ratio 0.85). Preoperative workup included renal ultrasound, voiding cystourethrogram, and DMSA/DTPA renal scan. Analyzed variables: operative time, laterality, complications, catheterization duration, hospital stay, and success rate. Results : The extravesical ureteral reimplantation using the Lich-Gregoir technique performed laparoscopically was successfully achieved in 61 children (65 ureteral units) without any conversion to open surgery. The mean operative time was 110 ± 25 minutes for unilateral and 145 ± 30 minutes for bilateral procedures, reflecting progressive technical mastery and reproducibility. No major intraoperative complications occurred. Postoperative recovery was uneventful in almost all cases, with a mean catheterization time of 24–48 hours and an average hospital stay of 2.4 ± 0.8 days, indicating rapid recovery and excellent postoperative comfort. The overall minor complication rate was 8%, limited to transient fever or delayed voiding, with no ureteral stenosis, urinary leakage, or secondary reimplantation. Functional outcomes were highly satisfactory, with a clinical and radiological success rate of 95%, confirmed by complete reflux resolution on postoperative cystography and the absence of recurrent urinary tract infections. Renal ultrasound demonstrated improved ureteral drainage and regression of pyelocaliceal dilatation. After a mean follow-up of 12 months, all children maintained normal spontaneous voiding, without dysuria or incontinence. These results confirm the safety, effectiveness, and long-term durability of laparoscopic Lich-Gregoir ureteral reimplantation, establishing it as a reliable, minimally invasive alternative to open surgery in the management of primary vesicoureteral reflux in children .