title: Laparoscopic simple nephrectomy after previous ipsilateral open versus percutaneous renal surgery.
abstract: OBJECTIVE
  Fibrosis after previous open or percutaneous renal surgery may interfere with ipsilateral laparoscopic nephrectomy. We prospectively compared the outcome of laparoscopic nephrectomy in patients with previous open renal surgery or percutaneous nephrolithotomy.
  
  
  METHODS
  During the study period, 38 patients with previous ipsilateral open renal surgery (n 22) or percutaneous nephrolithotomy (n 16) who underwent transperitoneal laparoscopic nephrectomy were evaluated. All patients had symptomatic nonfunctioning small or hydronephrotic kidneys.
  
  
  RESULTS
  Mean age was 57.6 y (range, 15 to 77). Both groups were age and sex matched. Two procedures (both in patients with previous open renal surgery) were converted to open surgery because of difficult pedicle dissection. Mean operative time was nonsignificantly longer in group 1 (111 versus 97 min; P .22). Intraoperative complications consisted of symptomatic capnothorax and diaphragmatic rupture in 1 case per group, managed successfully by inserting a chest tube or laparoscopic repair. Intraoperative blood loss and mean postoperative hematocrit drop were similar in the 2 groups. No significant differences were found between groups in postoperative variables, including time to oral intake, hospital stay, and time to ambulation.
  
  
  CONCLUSIONS
  Transperitoneal laparoscopic nephrectomy in patients with a history of ipsilateral open or percutaneous renal surgery is feasible in a timely manner. Given adequate laparoscopic experience, similar perioperative outcomes can be achieved in both groups. When laparoscopic nephrectomy is used, the precautions that need to be considered are similar for patients with previous percutaneous nephrolithotomy and those with previous open flank surgery.
authors.affiliation: Department of Urology, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. aminsharifi_ar@yahoo.com
authors.forename: Alireza
authors.initials: A
authors.lastname: Aminsharifi
authors.forename: Bahman
authors.initials: B
authors.lastname: Goshtasbi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult