19 PREDICTORS OF COMPLICATIONS OF LAPAROSCOPIC RETROPERITONEOSCOPIC TOTAL AND PARTIAL HEMINEPHRECTOMY
Caroline MacDonald, Robert Small, Martyn Flett, Salvatore Cascio, Stuart O'Toole
The Royal Hospital for Children, Glasgow, United Kingdom

Abstract

Aim of the Study

We are a large unit performing predominantly retroperitoneoscopic procedures.   We aim to review our outcomes and analyse the data to elucidate predictors of intra-operative complications and need for further surgery.

Methods

We performed a single centre retrospective review of children undergoing retroperitoneoscopic laparoscopic nephrectomy (RLPN) and retroperitoneoscopic laparoscopic partial nephrectomy (RLN) between 2005 and 2015.  Demographic, diagnostic and surgical variables were analysed for correlation with outcomes using chi2, t-test and spearman’s correlation.

Main Results

We performed 173 laparoscopic cases, 119 RLN and 54 RLPN.  Median age and weight: 5 years (6 months – 18 years) and 24.9kg (7.7 to 85kg), median operation time 2:27 hours. There were 4 conversions and 6 intraoperative complications.  26 children required further surgery which included 8 completion stumpectomy (2 with reimplant) and 2 completion nephrectomies.  

RLPN was not associated with higher rate of cumulative complication than RLN (27 vs 23% p=0.76) or increased LOS (mean 2 days p=0.62).  Predictors of intraoperative complication were hand tie or electrocautery vessel sealing.  Associations with need for reoperation included: diagnosis, degree of CKD, contralateral disease, bladder dysfunction, presence of PD catheter and need for concomitant procedure.   

Conclusion

Our conversion rate (2.3%) and intraoperative complication rates are favourable to the literature.  We have demonstrated that there is no association of heminephrectomy and intraoperative complications (OR 0.96 p=0.42) nor cumulative complication rate.  Need for reoperation is often associated with the underlying diagnosis and the natural sequelae of the disease process, rather than aspects of surgical technique.


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