Clinical Experience in the Treatment of Nephroptosis Using Retroperitoneal Laparoscopic Nephropexy

Abstract

Background: Retroperitoneal laparoscopic nephropexy has been applied to nephroptosis. We investigate the approach and treatment effect of retroperitoneal laparoscopic nephropexy. Methods: From May 1990 to October 2013, 45 patients with nephroptosis treated in our hospital were retrospectively analyzed. Among them, 25 patients underwent nephropexy (open surgery group), the other 20 patients underwent retroperitoneal laparoscopic nephropexy (laparoscopic surgery group). In open surgery group, there were 24 females and 1 male, aged 20 - 35 years. In laparoscopic surgery group, there were 19 females and 1 male, aged 20 - 35 years. All of them with nephroptosis of the right kidney were combined with lower back pain or hematuria and underwent intravenous pyelography (IVP) and color ultrasound in orthostatic and supine position for a specific diagnosis. In open surgery group, patients underwent open surgery. Their kidneys were fully dissociated, then, the upper and middle pole of the dorsal kidney was sutured with lumbar fascia for two stitches for fixation respectively. While in laparoscopic surgery group, kidneys were fully dissociated in Gerota’s fascia during laparoscopic surgery, and the upper pole of the dorsal kidney was sutured with the lumbar fascia for two stitches using a 2-0 absorbable suture. They were all in the supine position for a week after surgery. The body mass index (BMI), operation time, bleeding amount, postoperative hospital stay, wound complication rate and other indicators were compared between two groups. Results: BMI in open surgery group was 16.77 ± 0.80 kg/m 2 , BMI in laparoscopic surgery group was 16.73 ± 0.78 kg/m 2 , P > 0.05 showed no statistical difference; the operation time in open surgery group was 70.96 ± 10.61 min, that in laparoscopic surgery group was 34.65 ± 4.87 min, P < 0.001 showed highly statistical significance; the bleeding amount in open surgery group was 20.65 ± 6.48 ml, that in laparoscopic surgery group was 4.85 ± 1.63ml, P < 0.001 showed highly statistical significance; the postoperative hospital stay in open surgery group was 7.54 ± 1.28 d, that in laparoscopic surgery group was 7 d, P > 0.05 showed no statistical difference. In open surgery group, four patients had wound infection which delayed the healing, and the wound complication rate was 16% (4/25). In laparoscopic surgery group, wound complications did not appear, the incidence was 0%, X 2 = 1.8144, P > 0.05 showed no statistical difference. The mean follow-up visit lasted 1.5 years after surgery (3 months to 2 years), B-mode ultrasound in orthostatic and supine position showed kidneys were in the normal position. Compared with those before surgery, postoperative uncomfortable symptoms completely disappeared in all patients. Conclusions: Retroperitoneal laparoscopic nephropexy has a good effect on symptomatic nephroptosis. The two stitches of suture between the upper pole of the dorsal kidney and the lumbar fascia show convenient operation, less damage and faster postoperative recovery, which are better than open surgery.