Surgical Exposure and Repair of the Traumatized Kidney

Abstract

In the past, renal exploration after major trauma often resulted in total nephrectomy. With primary vascular control and meticulous reconstructive techniques, we have demonstrated that 87% of renal injuries requiring surgical exploration can be successfully reconstructed.6 Our goal for all renal explorations is to control renal bleeding, preserve the maximal amount of viable renal parenchyma, and minimize the degree of potential postoperative complications. We generally surgically reconstruct kidneys with major parenchymal lacerations or vascular injuries, particularly when concomitant intra-abdominal injuries are present. In our experience, renal exploration and repair can be performed safely on patients with major renal injuries. When reconstructive surgical tenets are strictly adhered to, the resulting loss of renal parenchyma and function is a direct result of the nature and severity of the initial renal injury itself. Of the surgically repaired blunt and penetrating renal injuries at San Francisco General Hospital (SFGH), we have been able to preserve more than one third of the injured kidney in about 80% of the cases.' Thus, surgical reconstruction of the kidney can successfully preserve function and is an appropriate method for managing major traumatic renal injuries. Kidney parenchymal preservation is often poor, however, in patients with renovascular injuries and in those with severe associated intra-abdominal injuries, shock, and major blood loss.