title: Preliminary vascular control for renal trauma.
abstract: Preliminary control of the renal vascular pedicle prior to opening Gerota's fascia is advocated as the standard approach for decreasing the rate of nephrectomy from trauma. This method, however, has not been studied widely. Previous reports failed to grade the severity of the renal injury and involved small patient series and historic control for comparison of nephrectomy rates. We studied 297 patients with renal trauma during a ten year period. Sixty-three of 75 patients with penetrating injuries and 12 of 222 patients with blunt injuries underwent renal exploration. We obtained vascular control prior to opening Gerota's fascia in 32 patients; it was obtained in 43 patients after opening Gerota's fascia. The nephrectomy rate depended on the degree of injury rather than on the type of renal vascular control obtained. Obtaining vascular control after opening Gerota's fascia did not increase the nephrectomy rate and shortened operative time by an average of 58 minutes. We recommend vascular control after opening Gerota's fascia when there is a large hematoma crossing the midline, a rapidly expanding renal hematoma, if the patient is unstable, or if Gerota's fascia has already been opened by the injury.
authors.affiliation: Department of Surgery, Humana Hospital, University of Louisville School of Medicine, Kentucky.
authors.forename: A
authors.initials: A
authors.lastname: Atala
authors.forename: F B
authors.initials: FB
authors.lastname: Miller
authors.forename: J D
authors.initials: JD
authors.lastname: Richardson
authors.forename: B
authors.initials: B
authors.lastname: Bauer
authors.forename: J
authors.initials: J
authors.lastname: Harty
authors.forename: M
authors.initials: M
authors.lastname: Amin
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D005205:Fascia / Q000098:blood supply / Q000293:injuries; D000071938:Fasciotomy; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D007668:Kidney / Q000098:blood supply / Q000293:injuries* / Q000601:surgery; D007674:Kidney Diseases / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D009392:Nephrectomy; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery*; D014950:Wounds, Penetrating / Q000150:complications / Q000601:surgery*