[Retroperitoneoscopic nephrectomy: our experience in short-term hospital stay].
OBJECTIVE
To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay.


METHODS
From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney's functional annulations, were: obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12).


RESULTS
In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization.


CONCLUSIONS
The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stayis lesser when the nephrectomy was performed by retro peritoneal approach than conventional surgery. Consequently this procedure can be carry out in a short hospital stay.
Luque Mialdea
R
R
Unidad de Laparoscopia. Sección Urología Pediátrica. Servicio Cirugía Pediátrica. Hospital Sur de Alcorcón, Sanatorio Nra. Sra. del Rosario, Madrid.
Martín-Crespo
R
R
Hemández
E
E
Cerdá
J
J
García-Casillas
M
M
Sánchez
O
O
Cañizo
A
A
Cebrian
J
J
López Gil
T
T
Blanco
T
T
Morales
L
L
Fernández
A
A
Luque de Pablos
A
A
Carrero
C
C
Moreno
L
L
D000293:Adolescent; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space