title: Laparoscopic versus open nephrectomy for xanthogranulomatous pyelonephritis: An outcome analysis.
abstract: BACKGROUND
  Current literature suggests that laparoscopic nephrectomy (LN) in patients with xanthogranulomatous pyelonephritis (XGP) is associated with high conversion and complication rate.
  
  
  OBJECTIVE
  To report contemporary outcome of patients with XGP, managed with either open nephrectomy (ON) or LN.
  
  
  METHODS
  In this retrospective study, medical records of 37 patients with histopathologically confirmed XGP from January 2001 to October 2009 were reviewed.
  
  
  METHODS
  The clinical presentation, preoperative course, intraoperative findings, postoperative recovery and complications in ON and LN were analyzed.
  
  
  METHODS
  Student's t test was used to perform statistical comparison between the LN and ON groups. Values are expressed as mean ± standard deviation.
  
  
  RESULTS
  In 37 patients, 20 underwent ON and 17 underwent LN. One patient in the LN group required conversion. He had ectopic pelvic kidney, and the vascular pedicle could not be identified because of dense adhesions. There were no intraoperative complications. The mean blood loss was 257.5 ± 156.67 ml and 141.18 ± 92.26 ml in ON and LN groups, respectively. Mean hospital stay was 15.45 ± 7.35 days and 9.71 ± 4.55 days in ON and LN groups, respectively. Postoperative complications were classified according to Clavien grading for surgical complications. Grade 2 complications were seen in 40% and 29.4% of patients in ON and LN groups, respectively. One patient in LN required secondary suturing of specimen retrieval site.
  
  
  CONCLUSIONS
  LN in patients with XGP is often challenging and requires considerable experience in laparoscopy. In properly selected patients, all benefits of minimally invasive surgery can be availed with LN.
authors.affiliation: Department of Urology, Muljibhai Patel Urology Hospital, Nadiad, Gujarat, India.
authors.forename: Kartik J
authors.initials: KJ
authors.lastname: Shah
authors.forename: Arvind P
authors.initials: AP
authors.lastname: Ganpule
authors.forename: Abraham
authors.initials: A
authors.lastname: Kurien
authors.forename: Veeramani
authors.initials: V
authors.lastname: Muthu
authors.forename: Ravindra B
authors.initials: RB
authors.lastname: Sabnis
authors.forename: Mahesh R
authors.initials: MR
authors.lastname: Desai