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.
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).
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.