anti reflux surgery(Politano-Leadbetter Technique )

Rate :
Loading player ... The player requires Flash Player plugin

Describtion



Politano-Leadbetter Technique                                  
 
The principle behind this technique, which was originally described
by Politano and Leadbetter (1958), is to bring the ureter in through
a new hiatus superior to the original insertion. A submucosal tunnel
is created in the direction of the trigone, medial to the original
orifice. The advantage of this technique is that a long tunnel can be
created, which is valuable in the higher grades of reflux. This antireflux
mechanism can be further supported by a psoas hitch.
Technique
After completion of the ureteral mobilization intravesically, the
location of new hiatus is selected in a straight line superior to the
original orifice (Fig. 137-17). With the bladder open and the lateral
walls retracted, the inexperienced surgeon might be inclined to
position the new hiatus too laterally on the posterior wall. Once
the bladder is closed and full, the ureter enters on the anterolateral
wall and then hooks back posteriorly toward the trigone, creating
the classic “hooking,” which is an important cause for postoperative
ureteral obstruction. In the original description of the Politano-
Leadbetter technique, the new hiatus was created blindly by passing
a right-angle clamp from the original hiatus behind the bladder to
Paquin described this combined extravesical/intravesical technique
in 1959 (Paquin, 1959). The new ureteral hiatus is created from
outside the bladder, thus avoiding the difficulties associated with
this maneuver in the Politano-Leadbetter technique. As with most
of the other open techniques, a success rate greater than 95% for
primary VUR is achieved with this method (Woodard and Keats,
1973).
The ureter in the Paquin technique can be approached extravesically
(see Extravesical Procedures) before opening the bladder. A
right-angle clamp is applied at the UVJ, the ureter is divided, and a
3-0 polyglactin suture is used to suture ligate the original hiatus.
The bladder is then opened in the midline, and a new hiatus is
created, located cephalad to the prior position. The peritoneum is
carefully cleared off the back wall of the bladder at the site of the
new hiatus. A right-angle clamp is passed from inside the bladder
under direct vision, and one end of a 5-mm Penrose drain is pulled
into the bladder. A mosquito snap is applied to the Penrose drain,
which acts as a holder and facilitates the creation of the submucosal
tunnel. The mucosa is dissected off the detrusor circumferentially
at the new hiatus. The length of the submucosal tunnel is governed
by the diameter of the ureter, and a 5 : 1 ratio is usually achievable.
In more complex cases a psoas hitch may be required to achieve a
longer tunnel length. The tunnel is developed by carefully lifting
the mucosa off the detrusor using tenotomy scissors. Countertraction
on the mucosa is helpful, especially in cases that must be
redone and when the bladder wall is trabeculated. Once the tunnel
is developed the remainder of the reimplants is similar to the
Politano-Leadbetter procedure.
The modified Paquin technique is particularly suited for dilated
ureters and complex (El-Sherbiny et al, 2002) and failed reimplants
(Mesrobian et al, 1985) because of the versatility offered by the
combined extravesical/intravesical approach to the ureter and the
ability to achieve longer submucosal tunnel lengths.



Untitled.jpgUntitled-jpg-1.jpg

Comments : 19

  • Mulley

    Professor   |     |  
      |   8/7/2020 5:50:03 PM
    My spouse and I absolutely love your blog and
    find many of your post's to be exactly I'm looking for.
    Would you offer guest writers to write content for you personally?

    I wouldn't mind composing a post or elaborating on most of the subjects you write regarding here.
    Again, awesome weblog!
  • Rubbo

    Professor   |     |  
      |   6/22/2020 11:09:49 AM
    Hello there! This post could not be written any better!
    Reading this post reminds me of my old room mate! He always kept talking
    about this. I will forward this article to him.
    Fairly certain he will have a good read. Many thanks for sharing!
  • Bloodsworth

    Professor   |     |  
      |   6/20/2020 10:18:28 AM
    I absolutely love your blog and find a lot of your post's to be
    exactly I'm looking for. Do you offer guest
    writers to write content available for you? I wouldn't mind producing a post
    or elaborating on a number of the subjects you write related
    to here. Again, awesome website!
  • Esteban

    Professor   |     |  
      |   7/17/2020 11:41:45 PM
    For the reason that the admin of this site is working, no
    doubt very rapidly it will be famous, due to its feature contents.
  • Kelliher

    Professor   |     |  
      |   9/16/2020 6:43:49 AM
    Hi there, all is going perfectly here and ofcourse every one is sharing data, that's genuinely excellent, keep up
    writing.
  • Allcot

    Professor   |     |  
      |   6/28/2020 8:26:54 AM
    WOW just what I was looking for. Came here by searching for اورولوژی
  • Brewster

    Professor   |     |  
      |   6/27/2020 10:00:28 PM
    I need to to thank you for this excellent read!!
    I absolutely enjoyed every little bit of it. I've got you
    bookmarked to look at new stuff you post…
  • Mcbee

    Professor   |     |  
      |   8/14/2020 6:08:25 PM
    Write more, thats all I have to say. Literally,
    it seems as though you relied on the video to make your point.
    You definitely know what youre talking about, why throw away your intelligence on just posting videos to your site when you could be giving us
    something informative to read?
  • Whittington

    Professor   |     |  
      |   9/12/2020 6:39:04 AM
    I don't even know how I ended up here, but I thought this post was great.

    I do not know who you are but certainly you're going to a famous blogger if you are
    not already ;) Cheers!
  • Berger

    Professor   |     |  
      |   1/23/2020 7:22:06 AM
    Academic Learning Of Urology Procedures - anti reflux surgery(Politano-Leadbetter Technique ) http://aktuality.sms.cz/kategorie/rss/countpage.php?idpage=1121544&ym=2014-09&idserver=1070&url=http://18.182.187.26/
  • Girard

    Professor   |     |  
      |   7/27/2020 4:39:10 PM
    Now I am ready to do my breakfast, after having my breakfast coming over
    again to read more news.
  • Crespin

    Professor   |     |  
      |   8/10/2020 8:30:05 AM
    Heya superb website! Does running a blog like this require
    a large amount of work? I have absolutely no expertise in programming however I had been hoping to start my own blog in the near future.
    Anyhow, should you have any recommendations or techniques for new blog owners please share.
    I understand this is off subject but I simply wanted to ask.
    Thanks a lot!
  • Burford

    Professor   |     |  
      |   7/25/2020 6:55:38 AM
    My programmer is trying to convince me to move to .net from PHP.
    I have always disliked the idea because of the costs.
    But he's tryiong none the less. I've been using Movable-type on numerous
    websites for about a year and am worried about switching to
    another platform. I have heard very good things about blogengine.net.
    Is there a way I can import all my wordpress posts into it?
    Any help would be really appreciated!
  • Goldberg

    Professor   |     |  
      |   8/7/2020 8:55:32 AM
    I savour, lead to I found just what I was taking a look for.
    You've ended my 4 day lengthy hunt! God Bless you man.
    Have a great day. Bye
  • Hannon

    Professor   |     |  
      |   9/21/2020 12:26:08 PM
    You really make it appear really easy along with your presentation but I in finding this matter too be
    really one thing tthat I feel I might never understand. It kind of
    feels too complex and extremely huge for me.

    I am looking forward for your next put up, I will try tto get the hold of it!

    site
  • Pepper

    Professor   |     |  
      |   7/22/2020 6:22:48 AM
    Everyone loves what you guys are up too. Such clever
    work and exposure! Keep up the good works guys I've incorporated
    you guys to my personal blogroll.
  • Fergerson

    Professor   |     |  
      |   6/26/2020 3:37:44 PM
    Everyone loves what you guys tend to be
    up too. Such clever work and exposure! Keep up the
    amazing works guys I've incorporated you guys to my blogroll.
  • Robb

    Professor   |     |  
      |   9/14/2020 8:58:18 PM
    I'm gone to say to my little brother, that he should also
    pay a quick visit this blog on regular basis to obtain updated from newest reports.
  • Levin

    Professor   |     |  
      |   8/6/2020 2:32:45 PM
    Hello there! I could have sworn I've been to this blog before but after checking through some
    of the post I realized it's new to me. Anyways, I'm
    definitely glad I found it and I'll be bookmarking and checking back frequently!
  • Leave message

    Your rating:
     
    Security code