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PubMed1977

Ureteral reimplantation: Lich method.

In utilizing the ureteral reimplantation procedure we have performed 76 reimplantations and have a 96 per cent success rate on our first operation. We review our clinical indications, material, and complications as well as our over-all results. We believe that this operation as outlined is as good or better than other previously reported types of ureteral reimplantation and has avoided some of the major hazards, including no postoperative obstruction.

Child↗
PubMed1993

Percutaneous transvesical ureteroscopy for removal of distal ureteral stone in reimplanted ureter.

In the past two decades, the widespread use of cross-trigonal ureteral reimplants for the treatment of children with vesicoureteral reflux has resulted in a large population of patients with transversely lying ureters. As this population gets older they will consequently be entering an age group at higher risk for stone and urothelial cancer formation, with the potential for diagnostic and/or therapeutic ureteroscopy. The anatomic orientation of the ureters resulting from a cross-trigonal reimplantation may create difficulty or even inability to perform transurethral ureteroscopy. This case presents the technique of percutaneous transvesical ureteroscopy for stone extraction in a seventeen-year-old male with a lower ureteral stone following cross-trigonal ureteral reimplantation. The described technique may serve as an addition to the current endoscopic methods.

Adolescent↗
PubMed1993

Reimplantation of ventral rootlets into the cervical spinal cord after their avulsion: an anterior surgical approach.

Root avulsions from the cervical spinal cord due to traction injuries are beyond repair up to the present day. An anterior surgical approach has been developed in cats for reimplantation of the ventral rootlets into the site of avulsion. The consecutive surgical steps towards exposure of the ventral surface of the cervical cord are given in detail. The morphological relations during the operative procedure are explained in the text and by illustrations. In this study the surgery related mortality rate was 16% and the overall mortality rate amounted to 21%. Loss of blood, initially a major problem, was coped with by increasing technical experience and the infusion of plasma expanding fluid. In 2 animals with survival times of 209 and 293 days respectively, many ventral horn motoneurons were found HRP-positive after retrograde HRP transport through the site of reimplantation. The findings provide evidence that the axonal continuity between reimplanted ventral roots and their motoneurons may be restored.

Animals↗
PubMed1992

Cochlear electrode reimplantation in the guinea pig.

Cochlear implants are being applied to an ever widening patient population, including children in whom lifetime use of these devices is anticipated. Replacement of implants can be expected for reasons of device failure as well as future upgrading. This investigation was undertaken to examine the effect of cochlear electrode explanation and reimplantation on spiral ganglion cell survival. Guinea pigs with normal ears were initially implanted and either explanted or explanted and reimplanted (at 2 months) with a single wire ball-tip intracochlear electrode or a silastic carrier (each remaining for an additional 2 months). Little loss of hair cells or auditory nerve was observed across experimental groups and normal controls. Restricted basal turn cochlear and spiral ganglion cell loss was observed in a few animals in each group and was likely associated with mechanical damage from initial implantation. Likewise the scattered organ of Corti damage and hair cell loss observed was noted in only a few cochleae in each experimental group. Therefore, no significant differences in the average pathology across experimental groups and controls were observed. Thus, explantation or explantation with subsequent reimplantation does not appear to constitute an additional significant pathological risk compared to implantation alone.

Animals↗
PubMed2006

Should a reimplantation valve sparing procedure be done systematically in type A aortic dissection?

OBJECTIVE: To evaluate the risks and benefits of a systematic reimplantation valve sparing procedure in the surgical treatment of type A aortic dissection (TAAD). PATIENTS AND METHODS: From February December 2005, 15 consecutive patients (mean age 61+/-12 years) who underwent surgery for TAAD were analyzed prospectively. Eleven had a preoperative CT-scan and all had an echography. Eight patients presented with a preoperative aortic insufficiency>2/4 and seven had an ascending aortic aneurysm over 50mm. In 11 cases, arterial cannulation was performed directly into the ascending aorta. Surgical technique included complete resection and replacement of the ascending aorta using a reimplantation valve sparing technique (David), associated in 12 patients with an arch replacement, under mild (29.7+/-3.0 degrees C) hypothermia and cerebral selective antegrade perfusion. RESULTS: Aortic clamping, cerebral perfusion and cardiopulmonary bypass (CPB) times were respectively 93+/-29, 18+/-9, and 131+/-38min. Mean bleeding at 24h was 1165+/-846ml. Troponin I level at 24h was 21+/-30 microg/l. One patient had a right coronary artery bypass for a chronically occluded coronary. Another had a triple arterial revascularisation for pre-existing coronary dissection. One patient presented with a postoperative regressive right hemiparesia (normal CT-scan). Two patients underwent revision for bleeding (one was undergoing treatment by clopidogrel). One patient had at day 7 an implantation of a covered stentgraft on the descending aorta for a concomitant penetrating aortic ulcer. One patient died suddenly on POD 7 during a tracheal aspiration. Intubation and ICU times were respectively 9.5+/-16.3 and 16.2+/-20.9 days. Four patients with severe preoperative co morbidities had long intubations. Echographic and CT-scan control, done in postoperative and after a mean follow up of 11.0+/-4.8 months, did not show any residual aortic insufficiency (actuarial survival rate at 2 years of 93.3%). CONCLUSION: A reimplantation valve sparing procedure in the TAAD seems to be reliable and should be proposed systematically without emphasizing perioperative morbidity.

Aged↗
PubMed2006

Laparoscopic ureteral reimplantation with extracorporeal tailoring for megaureter: a simple technical nuance.

PURPOSE: We describe a novel technique of extracorporeal tailoring for megaureter to perform laparoscopic extravesical transperitoneal ureteral reimplantation. We present our initial results with this procedure. MATERIALS AND METHODS: Three cases of megaureter were operated on laparoscopically. The 3-port technique was used (all 5 mm in 2 cases, and 2, 5 mm and 1, 10 mm in 1). The colon was reflected medially to expose the retroperitoneal course of the ureter. The ureter was gently dissected circumferentially down to the bladder. It was ligated close to the bladder and divided proximal to it. The free ureteral end was delivered out through the ipsilateral 5 mm port. The lower end was tailored over an 8Fr feeding tube. A 6Fr Double-J stent was placed. Later the whole assembly was carefully replaced in the abdomen. A Lich-Gregoir type extravesical reimplantation was done. RESULTS: Mean operating time was 220 minutes (range 210 to 240), which included 15 to 20 minutes to exteriorize the ureter, complete extracorporeal tailoring and replace the stented ureter in the abdomen. Mean blood loss was 40 ml. Cystourethrogram at 3 months did not demonstrate any reflux. Renal scan showed preserved renal function in all 3 cases, with prompt drainage in 2 and delayed drainage in 1. At a mean followup of 12 months all 3 patients were asymptomatic. CONCLUSIONS: Extracorporeal tailoring for obstructing megaureter is an easy and safe procedure that makes laparoscopic ureteral reimplantation simpler and quicker to perform.

Adolescent↗
PubMed2004

Comparison of modified Taguchi and Bricker ureteral reimplantation techniques after radical cystectomy.

OBJECTIVES: To present our experience with the modified Taguchi "single-stitch" ureteral reimplantation technique in patients undergoing radical cystectomy with urinary diversion compared with a traditional Bricker reimplantation technique. Improved techniques are continually sought for ureteroenteric anastomoses during urinary diversion. The modified Taguchi "single-stitch" ureteral reimplantation is reportedly a time-efficient technique that preserves anastomotic integrity. METHODS: We retrospectively examined 75 consecutive patients with bladder cancer who underwent cystectomy and urinary diversion between October 1, 1999 and March 31, 2001. The ureteroenteric anastomosis was performed using a reinforced single-stitch modified Taguchi technique in the first 36 patients and an interrupted two-layer Bricker technique in the subsequent 39 patients during the creation of 47 orthotopic neobladders and 28 ileal conduit diversions. Ureteral stents were not routinely used. The demographic and perioperative clinical parameters were evaluated in each cohort, with particular attention to ureteral complications. RESULTS: Modified Taguchi and Bricker ureteral anastomoses were performed in 48% and 52% of patients, respectively. Patient age, sex, and body mass indexes were similar between groups. Apart from pathologic stage, univariate analysis did not demonstrate statistically significant differences between the groups in the demographic, intraoperative (estimated blood loss, diversion type, operative time) or postoperative (length of stay, rate of complications) parameters. Ureteral complications occurred in 8% of the Bricker group and 15% of the modified Taguchi group (P = 0.23). CONCLUSIONS: Either technique can be performed safely and in a timely fashion. However, the increased number of ureteral leaks in the modified Taguchi cohort combined with no advantage in procedure time, prompted our return to the Bricker technique exclusively.

Anastomosis, Surgical↗
PubMed2002

Aortic valve reimplantation in ascending aortic aneurysm: risk factors for early valve failure.

BACKGROUND: Aortic root reconstruction by reimplantation of the native valve represents a new therapeutic option for ascending aortic aneurysms. Information about long-term follow-up is limited, and possible predictors for failure of reconstruction have not been evaluated so far. METHODS: After aortic valve reimplantation 101 patients were followed in a prospective observational study. From this cohort the first 75 consecutive patients with a complete 1-year follow-up were chosen for further analysis. Clinical and echocardiographic data were obtained preoperatively, intraoperatively, and early postoperatively, as well as after 1 year of follow-up. RESULTS: No mortality was observed within the first 30 days. There were 52 male patients, mean age was 49.1+/-20.6 years, observation period was 35.6+/-20.6 months, and Marfan's syndrome was present in 22 patients. Although in 67 patients a stable valve function could be demonstrated, 5 patients presented with mild aortic insufficiency or had to be operated on again for secondary valve failure (n = 3). Analyzing possible demographic, disease-related, and procedure-related risk factors in a multivariable approach, only level of coaptation within the graft (as assessed by echocardiography) could be identified as being related to the subsequent development of aortic insufficiency. Coaptation level within the tube graft (type A) resulted in a mean aortic regurgitation grade of 0.3+/-0.5 as compared with a mean grade of 2.5+/-0.6 for a coaptation type C (below the prosthesis; p < 0.001). CONCLUSIONS: Aortic valve reimplantation is a promising alternative to alloprosthetic composite replacement. A level of coaptation within the tube graft is essential to achieve valve competence.

Adolescent↗
PubMed2002

Analysis of valve motion after the reimplantation type of valve-sparing procedure (David I) with a new aortic root conduit.

BACKGROUND: The reimplantation type of valve-sparing procedure does not allow proper reconstruction of the sinuses of Valsalva. We assessed the valve motion after a reimplantation type (David I) of valve-sparing procedure using a new Dacron conduit that incorporates sinuses of Valsalva. METHODS: Nine consecutive patients undergoing an aortic valve-sparing procedure using the new conduit were studied using two-dimensional transesophageal echocardiography shortly (2 +/- 1 months) after operation to determine root distensibility, expressed as percent change in radius and as pressure strain of the elastic modulus. Next, monodimensional view was used to assess valve motion in its various phases (rapid valve opening velocity, slow closing leaflet displacement, rapid valve closing velocity, maximal leaflet displacement, and leaflet displacement before valve closure). Seven healthy individuals served as control subjects. RESULTS: Root distensibility was reduced at the level of the annulus and sinotubular junction but was similar to control subjects at the level of the sinuses (percent change in radius, 4.1% +/- 0.8% versus 4.5% +/- 1.2%; pressure strain of the elastic modulus, 1,286 +/- 674 g/cm2 versus 1,195 +/- 628 g/cm2). Rapid valve opening (69 +/- 34.4 cm/s versus 51 +/- 11.9 cm/s) and closing (47.6 +/- 16 cm/s versus 36.4 +/- 9 cm/s) velocity as well as slow closing leaflet displacement (24% +/- 4.7% versus 22.1% +/- 7.9%), maximal leaflet displacement (20.1 +/- 4 mm versus 22.7 +/- 1.9 mm), and leaflet displacement before valve closure (15.2 +/- 3 mm versus 17.6 +/- 0.8 mm) were similar to control subjects. CONCLUSIONS: The new aortic root conduit used in a reimplantation type of valve-sparing procedure allows the anatomic reconstruction of the aortic root with leaflet motion similar to that of normal subjects.

Aged↗
PubMed2003

Anatomic repair of anomalous left coronary artery from the pulmonary artery by aortic reimplantation: early survival, patterns of ventricular recovery and late outcome.

BACKGROUND: To determine the early and late outcomes of patients presenting with anomalous left coronary artery from the pulmonary artery who had repair by aortic reimplantation. METHODS: From January 1952 to July 2000, 67 patients presented with anomalous coronary artery from the pulmonary artery. Forty-seven patients who had repairs performed by aortic reimplantation are the subject of this study. The median age at repair was 7.7 months. Before repair, 10 infants (21%) presented in extremis requiring ventilatory and inotropic support, and 38 infants (80%) presented in heart failure. Autologous pericardial hood coronary arterioplasty was used in 4 patients, and concomitant mitral valve repair was used in 1 patient. RESULTS: Hospital survival was 92%. Five children required postoperative extracorporeal membrane oxygenation for a median of 4 days (range, 2 to 8 days). Patients who had extracorporeal membrane oxygenation were significantly more likely to have presented in critical condition (40% vs 3% if no extracorporeal membrane oxygenation; p = 0.006) or with ventricular arrhythmias (67% vs 7%; p = 0.027), to have presented with significantly lower preoperative repair median ejection fraction (10%, n = 5 vs 40%, n = 38; p = 0.01) or to have presented with more severe left ventricular dilatation (p = 0.03). Within a 15-year or less follow-up (mean, 4.7 years) there were no late deaths. Kaplan-Meier survival was 91% at 5 years, and freedom from reoperation was 93% at 10 years. At late follow-up, echocardiography demonstrated significant improvements in mean ejection fraction (64% +/- 9% vs 33% +/- 21% preoperatively, p < 0.0001); moderate mitral regurgitation (9% vs 38% preoperatively, p < 0.02); and wall motion abnormalities (15% vs 81% preoperatively, p < 0.002). The ratio of measured left ventricular end-diastolic dimension to the 95th percentile of normal declined from 1.4 +/- 0.3 to 1.0 +/- 0.1 (p < 0.0006). Children who had extracorporeal membrane oxygenation had normal ejection fractions and ventricular dimensions at follow-up (n = 3). Repeated measures of mixed linear regression analysis demonstrated that normalization of ejection fraction and left ventricular function occurred within 1 year of repair. Improvements in mitral regurgitation lagged behind normalization of ejection fraction and left ventricular dilatation. CONCLUSIONS: Anatomic repair of anomalous left coronary artery from the pulmonary artery by aortic reimplantation yields excellent early survival and late functional outcomes even in critically ill infants.

Adolescent↗
PubMed1986

The effect of site and technique of splenic tissue reimplantation on pneumococcal clearance from the blood.

The technique and site of reimplantation of splenic tissue influences survival of laboratory animals following intravenous injection of pneumococci. Splenic tissue was prepared by slicing, mincing, or grating the spleen. The tissue was placed subcutaneously, intraperitoneally, retroperitoneally, or in an omental pouch. This study was designed to determine the rate of pneumococcal clearance from the blood stream 16 weeks following splenic reimplantation by four different methods. All animals were challenged with an intravenous 1 mL bolus containing 10(7) bacteria. The New Zealand white rabbits were divided into six groups: intact spleen; splenectomized; spleen slices in an omental pouch; minced spleen in an omental pouch; splenic tissue implanted subcutaneously; and bits of spleen dropped into the peritoneal cavity. Animals with an intact spleen and those with spleen slices implanted into an omental pouch cleared bacteria during the first hour and all bacteria had disappeared at three hours. Bacteremia persisted longer than three hours in the other groups. Splenic tissue had regenerated in all animals with omental pouch implants, in four of six with minced spleen dropped into the peritoneal cavity but in only one with a subcutaneous implant. Reimplanted splenic tissue clears pneumococci from the blood stream best when thin slices of spleen are placed in an omental pouch. This technique also assures successful regeneration of splenic tissue.

Animals↗
PubMed1998

Valve-preserving replacement of the ascending aorta: remodeling versus reimplantation.

OBJECTIVE: Aortic valve regurgitation in combination with dilatation of the ascending aorta and root requires a combined procedure to restore valve function and eliminate pathologic dilatation of the proximal aorta. Two techniques have been proposed for this purpose; the aortic root may be either remodeled with an especially configured vascular graft or replaced with reimplantation of the aortic valve within the graft. We have used both techniques depending on the individual pathologic condition of the aortic root. METHODS: Of 107 patients undergoing operation for proximal aortic disease between October 1995 and November 1997, 40 patients had morphologically intact aortic valve leaflets in conjunction with dilatation of the aortic root. Of these, 15 patients underwent an operation as a surgical emergency for acute aortic dissection type A. In 29 instances, root remodeling in conjunction with ascending aortic replacement was performed; 11 patients underwent radical replacement of the proximal aorta with reimplantation of the aortic valve. Partial or total arch replacement was performed additionally in 27 of these patients. Other concomitant procedures were coronary artery bypass grafts (n = 11) and mitral reconstruction (n = 1). RESULTS: Two patients died after repair of acute aortic dissection, for a total operative mortality rate of 5%. No patient died after elective surgery. Aortic valve function could be effectively restored with both techniques. No patient underwent reoperation on the proximal aorta; freedom from aortic regurgitation of grade II or more at 1 year is 88% with both techniques. CONCLUSIONS: Depending on individual root pathologic condition, both the remodeling and the reimplantation techniques appeared to have their individual merits. Both result in adequate restoration of aortic valve function and elimination of pathologic aortic dilatation.

Adult↗
PubMed1996

Extravesical ureteral reimplantation: results in 128 patients.

PURPOSE: We evaluated the results of extravesical ureteral reimplantation in children. MATERIALS AND METHODS: We reviewed the records of 128 children (174 ureters) who underwent ureteral reimplantation via extravesical techniques. Primary vesicoureteral reflux was the most common diagnosis (73 patients). RESULTS: The extravesical technique produced a successful result in all patients (no reflux or obstruction). The 2 complications included postoperative urosepsis and transient urinary retention. CONCLUSIONS: Extravesical ureteral reimplantation is a reliable procedure with predictable results comparable to those of more traditional intravesical techniques.

Adolescent↗
PubMed2002

Comparing Taguchi and Lich-Gregoir ureterovesical reimplantation techniques for kidney transplants.

PURPOSE: We compared the incidence of urological and anastomotic complications, and the duration of ureteral reimplantation for the Taguchi and Lich-Gregoir techniques. MATERIALS AND METHODS: We recorded all urological and anastomotic complications that developed from the date of transplantation through December 31, 2001. The cutoff date for transplantation was August 30, 2000. The urological complications evaluated included complicated hematuria, urinary fistula, ureteral stenosis, symptomatic vesicoureteral reflux and operative time. The chi-square test was done to compare the proportion of complications in the groups and the Mann Whitney test was used to compare the duration of ureteral reimplantation. RESULTS: Of the 575 transplants evaluated 416 and 159 were performed via the Lich-Gregoir and Taguchi techniques, respectively. The incidence of anastomotic complications was 10.7%. Complications in the Lich-Gregoir group included fistula in 4.7% of cases, stenosis in 4.1%, symptomatic vesicoureteral reflux in 1.9% and complicated hematuria in 0.5%. Complications in the Taguchi group included urinary fistula in 6.3% of cases, stenosis in 2.5% and complicated hematuria in 2.5%. Symptomatic reflux was not observed in this group. There was a higher proportion of hematuria at the limit of statistical significance in the Taguchi group (p = 0.05). There were a higher number of urological complications in transplants from live donors in the Lich-Gregoir group (p = 0.01), mostly involving fistula (p = 0.05). There were no significant differences in the groups in overall complications. Average operative time for the Taguchi and Lich-Gregoir techniques was 14.2 and 29 minutes, respectively. This difference was significant (p = 0.02). CONCLUSIONS: In the sample studied Taguchi ureterocystoneostomy proved to be a more rapid method without increasing the incidence of urological or anastomotic complications. There were no cases of symptomatic reflux in the Taguchi group and select fistula cases could be managed conservatively. The Lich-Gregoir cohort was at greater risk for the urological complications of live donor transplantation. The Taguchi method has become the ureterovesical reimplantation technique of choice in our setting.

Adult↗
PubMed1994

The tapered and reimplanted small bowel as a variation of the Mitrofanoff procedure: preliminary results.

Ten patients with a urethra that could not be catheterized and with absent appendixes underwent neobladder construction using an ileal segment fashioned to serve as the anti-incontinence mechanism. The latter was tapered and reimplanted following the guidelines of the Mitrofanoff procedure. Urinary reservoirs were constructed from detubularized segments of right colon, sigmoid colon and composite gastro-ileal combinations. Followup ranged from 9 to 21 months (mean 14.5). All patients presently catheterize the reservoir satisfactorily and are free of urinary leakage. Three patients (30%) experienced initial catheterization difficulties: 2 required endoscopic procedures and insertion of a stent, and 1 with stomal stenosis was successfully treated with a Y-V stoma plasty. One patient (10%) required a repeat ileal segment reimplantation due to urinary incontinence. The higher reoperation rate and the increased surgical complexity of this procedure compared with reconstructions using the ileocecal valve as part of the anti-incontinence mechanism make this operation a less attractive alternative in the creation of a continent urinary reservoir. However, with comprehension of the need for careful and detailed surgical technique in its creation, the tapered and reimplanted ileal segment is a successful choice as an alternative for the creation of an abdominal wall stoma when the appendix is unavailable.

Adult↗
PubMed1987

Antireflux ureteroileal reimplantation: an alternative for urinary diversion.

Direct antireflux ureteroileal reimplantation with a short (2 to 2.5 cm.) intraintestinal ureteral segment was used in 14 patients with 26 ureters reimplanted into the ileum as part of a bladder augmentation procedure, substitution cystoplasty or continent supravesical diversion. Our incidence of reflux was 3.8 per cent (1 ureter), while ureteroileal obstruction occurred in 11.4 per cent (3 ureters). The over-all short-term technical success (maximum 18 months) with this operation was 84.8 per cent. These encouraging results make antireflux ureteroileal reimplantation an attractive alternative for its use in urinary tract reconstruction with ileal reservoirs.

Adolescent↗
PubMed1985

Transverse ureteral advancement technique of ureteroneocystostomy (Cohen reimplant) and a modification for difficult cases (experience with 121 ureters).

We reimplanted 121 ureters by the Cohen technique. A modification is introduced for difficult cases, making the Cohen technique more adaptable for dilated ureters and small bladders. Radiographic studies obtained at least 6 months after reimplantation revealed only 1 case of persistent reflux (grade I), no case of contralateral reflux and no obstruction. Even though the series included 35 ureters with grade V primary reflux and 7 primary obstructive megaureters, only 7 ureters were tapered. This finding suggests that the Cohen method might require tapering in a smaller percentage of cases compared to other reimplantation techniques.

Adolescent↗