Nephrolithotomy by one-layer interrupted parenchymal suture.

Abstract

Since 1967, when Taguchi devised a method of closing renal incisions in nephrolithotomy in which the renal capsule, parenchyma and pelvic mucosa are sutured together as one layer without prior hemostasis, this method, with subsequent modifications of surgical technique, has been employed in 47 cases of staghorn or multiple large calculi. The simplified method of suture shortens the clamp-time of the renal pedicle during operation, minimizes injury to the parenchyma, while assuring adequate hemostasis. All the treated cases showed good results postoperatively, free from any serious complications such as secondary hemorrhage. Renal function tests after nephrolithotomy by this method showed decreases of 20 and 16% in glomerular filtration rate and renal plasma flow, respectively, which returned to preoperative levels in 2 weeks. Pre- and postoperative renal arteriograms indicated some changes in the intrarenal arteries and parenchyma due to the incision and method of suture. Occlusion of intrarenal arteries occurred in 91.7% of the cases, in fact at the level of interlobar or minor artery in 90%, and the average number of sites of arterial interruption per kidney was 4.7. The author considers the method to be irrevocably perfect for renal parenchymal suture.