Successfully performed Pneumovesicoscopic Bilateral Ureteric Reimplantation in a 4 years old child

A 4 years old child with bilateral grade 4 Vesico-ureteric reflux and reflux nephropathy had Pneumo-Vesicoscopic ureteric reimplantation. Child had a very comfortable post operative period and discharged on 3rd post op day. This procedure is a paradigm shift from the conventional open cross trigonal ureteric reimplantation where a Pfannensteil (lower transverse) incision is usually made , bladder is opened and post surgery ureteric catheters are exteriorized per abdomen, requiring 7-10 days of postop recovery ,significant amount of analgesia, leaving a large scar; or conventional Laparoscopic extra vesical reimplantation ( not always suitable for dilated high grade refluxing ureters). In this procedure all the reimplantaion steps were carried out entirely within the domain of Urinary bladder by 3mm minilaparoscopic instruments , without any post op stents. The child had very comfortable recovery with minimal analgesia and left with barely appreciable scar. This relatively new technique has tremendously improved the quality of life of the reimplantation kids. There is no scar on her abdomen or perineum which is a great cosmetic benefit to the girl child. Fetal volvulous is an extremely rare condition and a challenge to diagnose and manage. Only few cases have been reported in the world literature with instances of fetal death , still births in neglected cases. It’s a complex multidisciplinary approach with state of the art NICU care which helps in survival of potentially morbid and lethal condition.

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