The efficacy of retroperitoneal laparoscopic deroofing of simple renal cyst with perirenal fat tissue wadding technique

Abstract

Treatment options for simple renal cyst (SRC) include open surgery, laparoscopy with decortication, or percutaneous aspiration with or without sclerotherapy. Though laparoscopic unroofing achieves better results than percutaneous sclerotherapy, the reported recurrence rate is still up to 19%. Thus, it is necessary to find methods to reduce the recurrence rate.To investigate whether the perirenal pedicled fat tissue wadding technique during retroperitoneal laproscopic deroofing (RLD) of SRC affects the incidence of recurrence.A retrospective analysis was carried out on clinical data of 254 patients with SRC treated by RLD in our hospital from 2008 to 2016. Among these patients,119 had a simple retroperitoneal deroofing (SRD) and 135 received a retroperitoneoscopic deroofing with wadding of the cyst using perirenal fat tissue (RDCW). The recurrence rate and variables, as well as perioperative complications, were compared. To further explore the potential variables influencing cyst recurrence rate, univariate and multivariate regression analyses were applied.A total of 251 patients were included in the analysis. The operation was successfully completed laparoscopically in all cases with no conversion to open surgery. No mortality or significant complication occurred in both groups. After a median follow-up of 38.67 months, we noted 41 recurrences. According to the univariate and multivariate regression analyses, patients managed with the wadding technique had superior recurrence-free survival (RFS), compared with patients in SRD group (log-rank P = .03 and P = .04, respectively). Moreover, patients with single renal cyst had a lower recurrence rate, compared with patients with multiple renal cysts (log-rank P < .01). Regarding the operation time, blood loss, and hospital stay, no statistically significant difference was found between 2 groups (P values .13, .30, and .75, respectively). However, less postoperative drainage and shorter postoperative interval until tube removal (P = .04) were observed in RDCW group.The perirenal pedicled fat tissue wadding technique can decrease the cyst recurrence rate and RCDW represents an effective and safe treatment option in the management of renal cysts.

Evaluation of renal cyst treatment using retroperitoneal laparoscopic decortication

“…Most of the cysts were located in the left kidney (39.4%), followed by right kidney (30.3%) and bilateral kidney (30.3%), with χ 2 = 0.545, p = 0.761; thus, the results were not considered statistically significant. These results were similar to other reports, such as those published studies by Nguyen Ngoc Anh (52.78%) 6 , Dinh Le Quy Van (42.1%) 7 , and Shicong Lai (55,1%) 9 . Most of the cysts were located in the lower pole (54.6%), followed by upper pole (42.4%) and peripelvic (3%), with χ 2 = 14.364, p = 0.001.…”

“…Simple aspiration or sclerotherapy is a minimally invasive procedure; however, the recurrence rate is very high. Open surgery offers a high success rate; however, it presents an invasive procedure with the comorbidity of flank incision 4,5 . The laparoscopic technique, however, not only has a high success rate but is also characterized by minimal invasiveness, low morbidity, and early recuperation, making it a preferred treatment 4,5 .…”

Aspiration-sclerotherapy versus laparoscopic de-roofing in the treatment of renal cysts: which is better?

“…To enhance the efficiency of LD treatment, Lai and colleagues [29] studied the impacts of perirenal pedicled fat tissue wadding technique (PPFTWT) on the recurrence rate during this surgery operation, they found that LD using PPFTWT can decrease the rate of cyst recurrence evidently. Inserting fat tissue into the cavity of the cyst and fixing it prevented the cyst wall from adhering to the residuary cyst wall or surrounding tissue, and contributed to the secretion drainage and absorption of the remaining cyst wall, thus declined the risk of cyst recurrence [30].…”

Aspiration-Sclerotherapy Versus Laparoscopic De-roofing in the Treatment of Renal Cysts: Which is better?

“…[27] Hence, LD could be the standard in the management of renal cysts, especially suited for patients failed after AS therapy. [28] To enhance the efficiency of LD treatment, Lai and colleagues [29] studied the impacts of perirenal pedicled fat tissue wadding technique (PPFTWT) on the recurrence rate during this surgery operation, they found that LD using PPFTWT can decrease the rate of cyst recurrence evidently. Inserting fat tissue into the cavity of the cyst and fixing it prevented the cyst wall from adhering to the residuary cyst wall or surrounding tissue, and contributed to the secretion drainage and absorption of the remaining cyst wall, thus declined the risk of cyst recurrence.…”