Вестник трансплантологии и искусственных органов (Nov 2016)

LAPAROSCOPIC NEPHRECTOMY IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

  • O. N. Reznik,
  • A. N. Ananiev,
  • E. S. Nevirovich,
  • V. S. Daineko,
  • A. E. Skvortsov,
  • A. A. Kutenkov,
  • D. O. Kuzmin

DOI
https://doi.org/10.15825/1995-1191-2016-3-50-56
Journal volume & issue
Vol. 18, no. 3
pp. 50 – 56

Abstract

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Aim. To assess the possibilities of the use of laparoscopic transabdominal nephrectomy (LNE) for surgical treatment and preparation of the patients with autosomal dominant polycystic kidney disease (ADPKD) for kidney transplantation. Materials and тethods. In the course of the study 28 patients who underwent nephrectomy of a polycystic-modifi ed kidney were analyzed and divided into two groups. The fi rst group (15 patients) underwent open surgical intervention with the use of midline laparotomy and lumbotomy (16 operations), of which: bilateral nephrectomy – 11 (68.7%), monolateral nephrectomy – 5 (31.3%). In the second group (13 patients), laparoscopic transabdominal monolateral nephrectomy (17 operations) was done. Surgical interventions were performed for emergency indications and to prepare for kidney transplantation. Results. The average duration of laparoscopic and open surgical interventions was not signifi cantly different and amounted in the fi rst and second group to 146 ± 14 and 124 ± 11 minutes (p > 0.05), respectively. The frequency of postoperative complications after open surgical interventions made up 43.75%, the mortality rate was 6.25% (1 case). In patients operated on laparoscopically postoperative complications occurred in 11.8% of cases. Patients after laparoscopic procedures were activated in 2–3 days (2.63 ± 0.23), after open operations on 4–5 (4.13 ± 0.39, p < 0.05). The average length of postoperative hospital stay was in the fi rst group – 13–14 (13.7 ± 1.3), in the second group – 7–8 (7.7 ± 0.5, p < 0.05). Conclusion. Atraumatic laparoscopic technology leads to a more favorable course of the postoperative period after nephrectomy. It can reduce the duration of inpatient treatment and help activate patients at an earlier date. The method of LNE can signifi cantly reduce the frequency of postoperative complications and expand the possibilities of using nephrectomy in the treatment and management of patients with autosomal dominant polycystic kidney disease waiting for renal transplantation.

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