Laparoscopic bladder 'wrap' technique for repair of vesicoureteric reflux in a porcine model.
OBJECTIVE
The aim of this study was to determine if vesicoureteric reflux (VUR) can be successfully corrected laparoscopically by a bladder "wrap" technique in a pig model.


METHODS
In 15 female piglets (mean weight, 22.5 kg) bilateral VUR was created by an open technique (11 grade 3, 2 each of grades 2 and 4). Eight weeks later (range, 4to 16 weeks) VUR was confirmed by fluoroscopic cystogram, and unilateral laparoscopic correction was performed. The contralateral ureter was used as a control. The bladder was emptied, and a 3F ureteric catheter was inserted on the repair side. Four 11-mm ports were inserted transperitoneally. The ureter was dissected to the ureterovesical junction (UVJ). Commencing at the UVJ, 2 (n = 9) or 3 (n = 6) black silk sutures were placed through the bladder muscle on either side of the ureter creating a bladder wrap around the distal 2 to 4 cm of ureter. At a mean of 16 weeks (range, 4 to 24 weeks) cystograms were repeated. The animals were killed the bladder and ureters underwent histopathology examination.


RESULTS
VUR was corrected in 12 animals (80%). There was persistence of VUR in 2 and ureteric obstruction in 1. The wrap was intact in all animals.


CONCLUSIONS
Laparoscopic correction of VUR by the bladder wrap technique is successful in pigs. Long-term follow-up studies will determine if this will be a satisfactory alternative surgical treatment for correction of VUR in children.
Cohen
R C
RC
Department of Paediatric Surgery, Royal Alexandra Hospital for Children, Westmead, NSW, Australia.
Moores
D
D
Cooke-Yarborough
C
C
Herrmann
W
W
D000818:Animals; D000831:Animals, Newborn; D004195:Disease Models, Animal; D005260:Female; D010535:Laparoscopy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012016:Reference Values; D013536:Suture Techniques; D013552:Swine; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D014718:Vesico-Ureteral Reflux / Q000601:surgery*