Laparoscopic transperitoneal and retroperitoneal nephrectomies in children: a change of practice.
BACKGROUND
Laparoscopic nephrectomies (LNs) may be performed in children with benign renal disease by the transperitoneal (TP) or retroperitoneal (RP) approach.


OBJECTIVE
The aim of this study was to present our early results from using both the laparoscopic transperitoneal and retroperitoneal approach, highlighting the change in the approach to a better, simpler procedure performed by experienced surgeons.


METHODS
Between February 2002 and June 2006, 30 LNs were performed, with the first 10 patients by TP (group 1) and the remaining patients by RP (group 2). Two patients were not included. Demographic data were compared: mean age (88 vs. 66.6 months), gender (30% female vs. 70% male), and laterality (60% left-handed vs. 40% right-handed). Other factors were assessed, as well: Operating time was compared, as was morbidity, analgesics requirement, postoperative hospital stay, and time to resume oral intake.


RESULTS
LN was performed in 28 of the 30 cases. One case in each group was converted. Both groups were similar regarding operating time (TP: 92.2 minutes vs. RP: 121.1), hospital stay (36.5 hours vs. 28.8), postoperative analgesia (2.1 doses of dipyrone and 1.2 doses of nalbuphine vs. 2.3 and 1.4). RP was associated with significantly faster postoperative analgesia tolerance than that of the TP approach (7.8 hours vs. 14.4; P < 0.05). Two (22.2%) patients in group 1 presented with vomiting, whereas no patients in group 2 had postoperative vomiting (P < 0.05). No further postoperative complications appeared.


CONCLUSIONS
In our hands, both laparoscopic TP and RP approaches are equally safe and effective, but the operating time was slightly shorter (not significant) and postoperative recovery significantly longer for TP. LN may be performed by both approaches, obtaining equal efficacy. TP may be associated with minimal paralytic ileus within the first 12-24 hours, meanwhile RP is related with better surgical skill and postoperative tolerance.
Baez
Julio J N
JJ
Department of Pediatric Surgery, Municipal Children's Hospital of Córdoba, Department of Pediatric Surgery, National University of Córdoba, Córdoba, Argentina. jjnbaez@hotmail.com
Luna
Camilo Mercado
CM
Mesples
Gastón F
GF
Arias
Alejo J
AJ
Courel
José M
JM
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space; D012189:Retrospective Studies