205 LONG-TERM FOLLOW UP OF TEN YEARS EXPERIENCE OF RETROPERITONEOSCOPIC LAPAROSCOPIC NEPHRECTOMIES IN A TERTIARY NEPHROLOGICAL UNIT
Robert Small, Caroline Macdonald, Martyn Flett, Salvatore Cascio, Stuart O'Toole
The Royal Hospital for Children (Formerly Yorkhill), Glasgow, United Kingdom

Abstract

Introduction

 

We perform retroperitoneal laparoscopic nephrectomy (RLN) for patients with benign disease.  Our unit works with a large tertiary nephrological unit and therefore care for a broader range of pathology than many series of laparoscopic nephrectomies.  We describe our experience with RLN, over ten years with minimum 2.5 years follow up.

 

Patients and Methods

 

We performed a single centre, retrospective review of all RLN between 2005 to 2015.  Primary outcomes were intraoperative and cumulative (combined intraoperative, early and late) complication rates. Association between patient co-morbidity and cumulative complication risk was tested using chi2.

 

Results

 

119 RLNs were identified (74 boys, 45 girls). Median age was 6 years (6 months to 18 years) and mean weight was 26.4kg (7.7 to 85kg). Median time of operation 147 minutes. Median LOS was 2 days (range 1-18 days), 45.9% discharged within 24 hours. Median follow up was 6 years (range 2.6 – 12.5 years).   

 

Intraoperative complication rate was 8.3% (including 3 conversions, 1 peritoneal breach, 1 perirenal leak). Late complications included 3 cases of residual stump reflux requiring completion stumpectomy, 2 returns of hypertension, 2 bladder dysfunction with 1 requiring ureterocele excision and mitrofanoff. Cumulative risk of complication was 20.2% (22/109).

 

There was significant co-morbidity with 10 nephrological and 4 with neuropathic bladder in our cohort (16/109).  This was not associated with significant increase in risk of complication (p=0.8).

 

Conclusion

 

We report the largest single cohort of RLNs in the literature. We report a 20.9% cumulative complication rate overall, however there is no demonstrable association between patient co-morbidity and increased complication rate.


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