The optimum approach for pre-transplant bilateral nephrectomy in small kidneys: dorsal lumbotomy vs laparoscopy.
OBJECTIVE
To evaluate the outcomes of bilateral pretransplant nephrectomy (BPN) for small kidneys, using a bilateral dorsal lumbotomy (BDL) or transperitoneal laparoscopy (TL) approach.


METHODS
Fifty-eight patients with end-stage renal disease and small kidneys underwent BPN for various indications, most commonly uncontrolled hypertension. There were 38 patients in the BDL group (group 1) and 20 in the TL group (group 2). The variables before and during surgery, and the outcomes afterward, were compared between the groups.


RESULTS
The mean age of the patients and male/female ratio were comparable in both groups. The mean size of the kidneys removed were 7.4 and 8.2 cm, respectively, in groups 1 and 2. The mean (range) operative duration was longer in group 2, at 210 (160-240) min, than in group 1, at 112 (90-150) min (P < 0.001). The postoperative analgesic requirement for pain, blood transfusion rate, wound and pulmonary complications were similar between the groups. Bowel function recovered earlier in group 1 than group 2 (19 vs 37 h, P < 0.001). The total cost for the nephrectomy in group 2 was 3.5 times that of group 1. The mean interval between nephrectomy and transplantation was similar in both groups.


CONCLUSIONS
BDL appears to be better than TL for BPN in small kidneys because the surgery is quicker, and there is earlier bowel recovery and lower costs.
Srivastava
Aneesh
A
Department of Urology and Renal Transplantation, SGPGIMS, Lucknow, Uttar Pradesh, India. aneesh@sgpgi.ac.in
Muruganandham
Kaliyaperumal
K
Gupta
Parag
P
Dubey
Deepak
D
Kapoor
Rakesh
R
Kumar
Anant
A
Gupta
Amit
A
Sharma
Raj Kumar
RK
D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000209:etiology / Q000601:surgery*; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods* / Q000473:pathology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D009929:Organ Size; D010149:Postoperative Pain / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult