The choice of nephrectomy method in patients with terminal hydronephrosis

Abstract

Background. Nowadays, with development of modern technologies in surgery, the priority is more frequently given to minimally invasive methods if compared to open techniques. In this aspect, it is important to find out the indications and contraindications when choosing various surgical approaches for nephrectomy in patients with terminal hydronephrosis. The presence of different clinical features of the disease requires optimization of surgical techniques. The purpose of the work was to increase the effectiveness of nephrectomy in patients with terminal hydronephrosis by determining the indications for minimally invasive surgical intervention. Materials and methods. There were 61 patients with terminal hydronephrosis under our observation: 39 women and 22 men. The average age of patients was 45.3 ± 5.8 years. According to the used surgical approach, 61 patients were divided into three representative groups by age, sex and clinical form of the disease. Group I included 23 patients who underwent laparoscopic nephrectomy with transperitoneal approach. Group II consisted of 18 patients who underwent hand-assisted laparoscopic nephrectomy. In 20 patients of group III, nephrectomy was performed using retroperitoneal endovideoscopic approach. Differences in the parameters of the postoperative period in groups with different endovideoscopic approaches for nephrectomy were considered statistically significant at p < 0.05. Results. Laparoscopic and retroperitoneoscopic nephrectomy according to the basic parameters of the perioperative period are significantly less traumatic than hand-assisted nephrectomy. However, the use of hand-assisted nephrectomy allowed us to reduce the operative time. In case of previous surgical interventions on the abdominal organs, retroperitoneal approach is recommended. In case of previous interventions on the retroperitoneal space on the side of hydronephrosis, the use of transperitoneal approach is advisable, which also enables simultaneous surgeries. In the presence of kidney stones and fibro-sclerotic paranephral process in patients with terminal hydronephrosis, hand-assisted nephrectomy should be the method of choice. Conclusions. In case of uncomplicated terminal hydronephrotic transformation, the use of laparoscopic or retroperitoneoscopic nephrectomy is significantly less traumatic than hand-assisted nephrectomy (p < 0.05) comparing average intraoperative blood loss, duration of postoperative analgesia, start of independent nutrition and hospital stay. Retroperitoneal nephrectomy is recommended for patients with history of any abdominal surgery. In patients with terminal hydronephrosis and excessive weight, it is expedient to have retroperitoneal approach using an additional fourth trocar. Transperitoneal laparoscopic approach is indicated in case of previous surgeries on the retroperitoneum by conducting nephrectomy and, if necessary, performing simultaneous interventions on the abdominal organs. The use of hand-assisted nephrectomy allowed reducing operative time to 94.8 ± 8.3 min, compared with transperitoneal (115.4 ± 11.2 min) and retroperitoneal (120.2 ± 9.6 min) approaches (p < 0.05). The presence of renal calculi and fibro-sclerotic paranephral process in patients with terminal hydronephrosis determine the benefits of this method.