title: Laparoscopic colorectal surgery in patients with impaired renal function: impact on postoperative renal function compared with open surgery.
abstract: BACKGROUND
  Laparoscopic surgery has been associated with a perioperative decrease in renal function. As a result, an open approach may be preferred in patients with impaired renal function when prolonged laparoscopic procedures are anticipated. The aim of this study was to examine changes in renal function following colorectal operations and compare between the open and the laparoscopic approaches, in patients with preoperative impaired renal function.
  
  
  METHODS
  This is a single-center retrospective study. Records of all patients with impaired renal function (estimated glomerular filtration rate [eGFR] <60 mL/minute) who underwent elective colorectal resection between 2007 and 2011 were reviewed. The changes in eGFR were examined and compared between open and laparoscopic procedures.
  
  
  RESULTS
  Ninety consecutive patients with impaired renal function who underwent elective colorectal surgery from 2007 to 2011 were identified. Forty-seven patients underwent laparoscopic surgery, and 43 had an open surgery; 23.2% of the patients who had open surgery and 21.7% of the patients who underwent a laparoscopic procedure demonstrated a decrease in eGFR at the time of discharge (P=not significant). The mean decrease in eGFR did not differ between the two groups (6.3 ± 6.8 mL/minute versus 4.04 ± 4.01 mL/minute; P=.34). None of the patients required dialysis. Postoperative complications were found to be a risk factor for a significant decrease in renal function.
  
  
  CONCLUSIONS
  Renal function may deteriorate in patients with chronic kidney disease who undergo elective colorectal surgery. No difference was noted in the incidence or severity of such deterioration between open and laparoscopic approaches. Postoperative complications are associated with deterioration in renal function regardless of the operative approach.
authors.affiliation: 1 Department of Surgery B, Meir Medical Center and Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel .
authors.forename: Roy
authors.initials: R
authors.lastname: Inbar
authors.forename: Loren
authors.initials: L
authors.lastname: Swissa
authors.forename: Ron
authors.initials: R
authors.lastname: Greenberg
authors.forename: Ian
authors.initials: I
authors.lastname: White
authors.forename: Guy
authors.initials: G
authors.lastname: Lahat
authors.forename: Shmuel
authors.initials: S
authors.lastname: Avital
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods; D017558:Elective Surgical Procedures; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007677:Kidney Function Tests; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors