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Laparoscopic simultaneous bilateral pretransplant nephrectomy for uncontrolled hypertension
K V Sanjeevan1, H S Bhat, S Sudhindran
1Amrita Institute of Medical Sciences and Research Centre, Kerala, India.
Transplantation Proceedings
|November 3, 2004
Summary
Simultaneous bilateral laparoscopic nephrectomy is a feasible and less morbid option for patients with end-stage renal disease and severe hypertension. This surgical approach effectively manages uncontrollable hypertension, unlike angioembolization which can complicate future laparoscopic procedures.
Area of Science:
- Nephrology
- Surgical Oncology
- Urology
Background:
- Severe hypertension resistant to multiple antihypertensive drugs often necessitates pretransplant renal ablation.
- Traditional methods like surgery or angioembolization carry risks including pain, postinfarction syndrome, and potential ineffectiveness.
Observation:
- This study presents the experience with simultaneous bilateral laparoscopic nephrectomies in two patients with end-stage renal disease and severe uncontrollable hypertension.
- One patient, previously treated with angioembolization, experienced a dense perirenal reaction that precluded laparoscopic surgery.
Findings:
- Bilateral laparoscopic nephrectomies were successfully performed in two patients, with operating times of 260 and 280 minutes.
- Within one month post-surgery, all patients achieved normotension with minimal or no antihypertensive medication.
- Prior angioembolization can significantly hinder or prevent subsequent laparoscopic surgery due to perirenal reactions.
Implications:
- Simultaneous bilateral laparoscopic nephrectomy is a viable and less morbid surgical option for managing severe hypertension in end-stage renal disease patients.
- Laparoscopic nephrectomy offers an effective alternative to traditional ablation methods.
- The potential complications of prior angioembolization must be considered when planning pretransplant nephrectomy.