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The optimum approach for pre‐transplant bilateral nephrectomy in small kidneys: dorsal lumbotomy vs laparoscopy
Author(s) -
Srivastava Aneesh,
Muruganandham Kaliyaperumal,
Gupta Parag,
Dubey Deepak,
Kapoor Rakesh,
Kumar Anant,
Gupta Amit,
Sharma Raj Kumar
Publication year - 2009
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2009.08485.x
Subject(s) - medicine , nephrectomy , bilateral nephrectomy , surgery , laparoscopy , renal function , group b , dorsum , transplantation , analgesic , blood transfusion , kidney , urology , anesthesia , anatomy
OBJECTIVE To evaluate the outcomes of bilateral pretransplant nephrectomy (BPN) for small kidneys, using a bilateral dorsal lumbotomy (BDL) or transperitoneal laparoscopy (TL) approach. PATIENTS AND METHODS Fifty‐eight patients with end‐stage renal disease and small kidneys underwent BPN for various indications, most commonly uncontrolled hypertension. There were 38 patients in the BDL group (group 1) and 20 in the TL group (group 2). The variables before and during surgery, and the outcomes afterward, were compared between the groups. RESULTS The mean age of the patients and male/female ratio were comparable in both groups. The mean size of the kidneys removed were 7.4 and 8.2 cm, respectively, in groups 1 and 2. The mean (range) operative duration was longer in group 2, at 210 (160–240) min, than in group 1, at 112 (90–150) min ( P < 0.001). The postoperative analgesic requirement for pain, blood transfusion rate, wound and pulmonary complications were similar between the groups. Bowel function recovered earlier in group 1 than group 2 (19 vs 37 h, P < 0.001). The total cost for the nephrectomy in group 2 was 3.5 times that of group 1. The mean interval between nephrectomy and transplantation was similar in both groups. CONCLUSION BDL appears to be better than TL for BPN in small kidneys because the surgery is quicker, and there is earlier bowel recovery and lower costs.