Técnica de Lich-Gregoir modificada sem cateter duplo J e com retirada precoce da sonda vesical para transplantes renais
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Data
2023-07-12
Autores
Astolfi, Rafael Haddad[UNIFESP]
Orientadores
Aguiar, Wilson Ferreira [UNIFESP]
Tipo
Tese de doutorado
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ISSN da Revista
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Resumo
Objetivo: Analisar a eficácia e a segurança de uma técnica de ureteroneocistostomia extravesical a Lich-Gregoir modificada, quando comparada à técnica tradicional. Métodos: Este estudo de coorte retrospectivo comparou os resultados pós-operatórios de 100 pacientes consecutivos submetidos a uma técnica de Lich-Gregoir modificada, operados entre Outubro de 2018 a Novembro de 2019, com os de uma coorte histórica de 165 pacientes consecutivos transplantados utilizando a técnica tradicional de Lich-Gregoir, que haviam sido operados entre Janeiro de 2017 e Setembro de 2018. Todos os transplantes foram realizados pelo mesmo cirurgião. O seguimento foi de 6 meses. Resultados: As características demográficas eram comparáveis entre os grupos, embora os pacientes do grupo da técnica de Lich-Gregoir modificada fossem ligeiramente mais jovens (37,6±13,8 vs. 42,0±14,0 anos, p=0,012). Os pacientes do grupo da técnica modificada foram submetidos com sucesso à remoção precoce da sonda vesical de demora (2,2±0,9 vs. 4,8±4,8 dias, p<0,001), sem que tenha havido diferenças na incidência de complicações cirúrgicas, incluindo fístulas urinárias (1 vs. 3%, p=0,284). Ademais, os pacientes do grupo da técnica modificada também apresentaram um menor tempo de internação hospitalar (6,5±5,0 vs. 7,1±6,2 dias, p=0,023). Conclusões: Esta técnica de Lich-Gregoir modificada permite a remoção segura e precoce da sonda vesical de demora em pacientes transplantados renais e está associada a uma redução no tempo de internação hospitalar.
Objective: To analyze the efficacy and safety of a modified Lich-Gregoir extravesical ureteroneocystostomy technique compared to the traditional technique. Methods: This retrospective cohort study compared the postoperative outcomes of 100 consecutive patients undergoing a modified Lich-Gregoir technique, who underwent sugery between October 2018 and November 2019, with those of a historical cohort of 165 consecutive patients transplanted using the traditional Lich-Gregoir technique, who had had undergone surgery between January 2017 and September 2018. All transplants were performed by the same surgeon. Follow-up was 6 months. Results: Demographic characteristics were comparable between the groups, although patients in the modified Lich-Gregoir technique group were slightly younger (37,6±13,8 vs. 42,0±14,0 years, p=0,012). Patients in the modified technique group were successfully submitted to early removal of the indwelling bladder catheter (2,2±0,9 vs. 4,8±4,8 days, p<0,001), with no significant differences in the incidence of surgical complications, including urinary leakage (1 vs. 3%, p=0,284). Furthermore, patients in the modified technique group also had a reduced length of hospital stay (6,5±5,0 vs. 7,1±6,2 days, p=0,023). Conclusion: This modified Lich-Gregoir technique allows safe and early removal of indwelling urinary catheter in renal transplant patients and is associated with a reduction in hospital length of stay.
Objective: To analyze the efficacy and safety of a modified Lich-Gregoir extravesical ureteroneocystostomy technique compared to the traditional technique. Methods: This retrospective cohort study compared the postoperative outcomes of 100 consecutive patients undergoing a modified Lich-Gregoir technique, who underwent sugery between October 2018 and November 2019, with those of a historical cohort of 165 consecutive patients transplanted using the traditional Lich-Gregoir technique, who had had undergone surgery between January 2017 and September 2018. All transplants were performed by the same surgeon. Follow-up was 6 months. Results: Demographic characteristics were comparable between the groups, although patients in the modified Lich-Gregoir technique group were slightly younger (37,6±13,8 vs. 42,0±14,0 years, p=0,012). Patients in the modified technique group were successfully submitted to early removal of the indwelling bladder catheter (2,2±0,9 vs. 4,8±4,8 days, p<0,001), with no significant differences in the incidence of surgical complications, including urinary leakage (1 vs. 3%, p=0,284). Furthermore, patients in the modified technique group also had a reduced length of hospital stay (6,5±5,0 vs. 7,1±6,2 days, p=0,023). Conclusion: This modified Lich-Gregoir technique allows safe and early removal of indwelling urinary catheter in renal transplant patients and is associated with a reduction in hospital length of stay.