The Risk of Arteriovenous Fistula Formation After En Bloc Stapling of the Renal Hilum During Transperitoneal Laparoscopic Nephrectomies

Abstract

Our aim was to evaluate the risk of arteriovenous fistula (AVF) formation after en bloc stapling of the renal hilum during transperitoneal laparoscopic nephrectomies (LNs). A retrospective review of 35 laparoscopic simple or radical nephrectomies or LNs was carried out. Patients were clinically followed up for renal hilar AVF formation, which could lead to new onset diastolic hypertension, abdominal murmur, and congestive heart failure. In addition, abdominal computed tomography and arteriography were carried out to diagnose renal hilar AVF formation during 6 to 20 months' follow-up. No statistically significant differences were measured between the systolic and the diastolic blood pressures between the preoperative and the postoperative periods (P>0.005). Abdominal murmur and new-onset congestive heart failure were not detected in any of the patients on physical examination. Our results suggest that en bloc stapling of the renal hilum during LN procedures is safe and effective.

Safety and efficacy of en bloc renal hilum control during laparoscopic nephrectomy and nephroureterectomy

“…[ 4 ] On the other hand, even with separate ligation of the artery and vein, AVF could be a result of inflammation and adhesion. [ 5 ] The most extensive series of AVF research was conducted by Lacombe, where he reported 62 cases of AVF following nephrectomy. However, this mode of ligation was available only for 14 of the 62 patients, 12 of whom successfully underwent en bloc.…”

“…As a result, en bloc ligation was assumed to be the reason for AVF, even though 48 patients in the cohort did not undergo this mode of ligation. [ 1 2 4 5 6 ] In our series 91 out of 126 patients were followed up either by CT with contrast or MRI depending on renal function tests. 71 patients for oncological purpose, 20 patients with benign causes where followed up for different indication such as evaluation of renal bed and contralateral kidney.…”

“…Infection and its associated inflammation increase a patient’s risk of AVF as an independent factor, whether separate ligation or en bloc pedicle control. [ 5 7 ] In a retrospective review by Sherer et al , 69 patients out of 433 underwent en bloc pedicle control for inflammatory renal disease with a mean follow-up of 51 months, of which none of the patients were followed up by imaging showing evidence of AVF. [ 8 ] Another review by Conradie et al ., which included some patients with active infections during the procedure with EBSH, none of them developed AVF.…”