This challenging procedure has successful outcomes: Laparoscopic nephrectomy in inflammatory renal diseases

Abstract

In prospective study from November 2011- November 2013, we performed 44 laparoscopic nephrectomies for benign non-functioning kidney diseases. Twenty eight patients underwent laparoscopic transperitoneal nephrectomies (63.6%), ten were laparoscopic assisted (22.7%) and six (13.6%) were converted to open. Patient's age, gender, laterality and etiology of renal failure were noted. Outcomes were measured as operative time, intraoperative and post operative complications, blood loss, pain score and hospital stay. Patients were followed up at one, three and 12 weeks and 6 monthly thereafter. Of the 44, ten (22.7%) were 15-24 years old, 32 (72%) between 25-50 years and two were more than 50 years old. Females were 54.6%. 22 patients had either right or left nephrectomy. Pelviureteric-junction (PUJ) obstruction was the commonest cause, 26 cases (59.0%). Operative time: less than two hours in 30 (68.2%) patients, more than two hours in 14 cases. Blood loss: less than 100 ml in 12 (27.3%), 100-200 ml in 20 (45.4%) and more than 200 ml in 12 (27.3%) patients. All four major complications were converted to open, two had injury to mesocolic veins and two had vascular stapler malfunction. Post-operative complications: surgical site infection (SSI), paralytic ileus and mild grade fever in six cases each and non infected benign intra abdominal collection in two cases. Maximum pain score on POD-1: four in 20 cases (45.7%), two in 24 (54%). Two had pain score between 3-4 three weeks after surgery. Oral intake started by POD-2 in 30 (68.2%) and by POD-4 in 100% cases. 22 (50%) patients were ambulating by POD-2, 16 (36.7%) by POD-4. Our study and randomized and non-randomized published literature report acceptables complication and conversion rates. In conclusion, laparoscopic nephrectomy for benign non functional kidney is a better alternative to open nephrectomy

Laparoscopic Nephrectomy in Benign Renal Diseases- A Tertiary Hospital Experience

“…also reported 17% conversion rate in laparoscopic nephrectomy in inflammatory benign disease which is near to our study 13 . Another study also showed conversion rate of 13.63% (6 out of 44) and their indication for conversion were also almost same as our study included profuse bleeding from hilar vessels and injury to mesocolic veins and inability to identify the kidney laparoscopically 14 . Comparing the conversion with the histopathological report 5 out of 6 converted cases were related to inflammatory benign diseases.…”

Initial Experience with Laparoscopic Nephrectomy at Services Hospital Lahore

“…These results were similar to many other studies in which patients treated with laparoscopic nephrectomy had less conversion rate, less blood loss and less hospital stay as compared to conventional open surgical procedure. 20,21…”

Laparoscopic retroperitoneal approach for urinary tract surgery. Predictive factors of complications and conversion to open surgery

“…Other authors report more blood loss, mainly related with the greater complexity of the surgical technique. (16) In an initial study of 200 cases, Rassweiler et al (4) reported 7.5% conversion to open surgery, Gill et al (17) 6.6%, Srivastava et al (3) 3.2%, whereas Al-Otabi et al (18) informed 0.7%. (3,18) Conversion to open surgery is not, necessarily, considered a complication, but it does reflect the learning curve of the surgeon.…”