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| Minimally invasive nephrectomy for inflammatory renal disease |
Paula Andrea Peñaa,Lynda Torres-Castellanosb,Germán Patiñoc,Stefanía Pradab,Luis Gabriel Villarragab,Nicolás Fernándezd,e,f,*( )
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aPontificia Universidad Javeriana, School of Medicine, Bogotá D.C., Colombia
bDepartment of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, School of Medicine, Bogotá D.C., Colombia
cDivision of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
dDivision of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, School of Medicine, Bogotá D.C., Colombia
eDepartment of Urology, Fundación Santa Fe de Bogotá, Colombia
fDivision of Urology, Hospital for SickKids, University of Toronto, Toronto, Canada |
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Abstract Objective: Once chronic inflammatory renal disease (IRD) develops, it creates a severe peri-fibrotic process, which makes it a relative contraindication for minimally invasive surgery (MIS). Our objective is to show that laparoscopic nephrectomy (LN) is a surgical option in IRD with fewer complications and better outcomes.
Methods: Retrospective review of patients who underwent a modified-surgical laparoscopic transperitoneal nephrectomy was performed. Data search included all operated patients between May 2013 and May 2018 that had a pathology result with any renal inflammatory condition (xanthogranulomatous pyelonephritis, chronic nephritis, and renal tuberculosis). We describe intra-operative variables such as operative time, blood loss, conversion rate, postoperative complications and length of hospital stay.
Results: There were 51 patients who underwent laparoscopic nephrectomy with a confirmatory pathology report for IRD. We identified four (8%) major complications; three of them required transfusion and one conversion to open surgery. The mean operative time was 233±108 min. Mean estimated blood loss was 206±242 mL excluding the conversion cases and 281±423 mL including them. The mean length of hospital stay was 3.0±2.0 days.
Conclusion: Laparoscopic nephrectomy for IRD can safely be done. It is a reproducible technique with low risks and complication rates. Our experience supports that releasing the kidney first and leaving the hilum for the end is a safe approach when vascular structures are embedded into a single block of inflammatory and scar tissue.
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Received: 01 January 2019
Available online: 14 September 2019
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Corresponding Authors:
Nicolás Fernández
E-mail: fernandez.j@javeriana.edu.co;nicolasfernandezb@gmail.com
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| Demographic data | N=51 | | Age, range, year | 1-68 | | Sex, n (%) | | Women | 39 (76) | | Men | 12 (24) | | Side, n (%) | | Right | 21 (41) | | Left | 30 (59) | | Personal history, n (%) | | Urolithiasis | 25 (49) | | UTI | 19 (37) | | HBP | 16 (31) | | VUR | 7 (14) | | DM II | 5 (10) | | Ureteral stricture | 11 (21) | | Primary obstructive megaureter | 1 (2) | | Duplex collecting system | 1 (2) | | Neurogenic bladder | 1 (2) |
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Demographic data of patients with inflammatory renal disease.
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| Post-surgical complications | Clavien-Dindo score | N=51 | | Pleural effusion | IIIa | 1 | | Dehiscence | I | 1 | | SSI | II | 2 | | Ileum | II | 1 | | AMI | IVa | 1 | | PTE | IVa | 1 | | Evisceration | IIIb | 1 |
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Post-operative complications classified by Clavien-Dindo's grading system.
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| Parameter | No conversion to open surgery, n=48 (94%) | Conversion to open surgery, n=3 (6%) | Total, n=51 | | Operative time, mean±SD, min | 223±99 | 400±144 | 233±108 | | Estimated blood loss, mean±SD, mL | 206±242 | 1 483±898 | 281±423 | | Days hospitalized, mean±SD, day | 2.9±2.0 | 5.7±2.0 | 3.0±2.0 |
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Operative data on inflammatory renal conditions.
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