Laparoscopic splenorenal venous bypass for nutcracker syndrome

Area of Science:

• Urology
• Vascular Surgery
• Minimally Invasive Surgery

Background:

• Nutcracker syndrome involves extrinsic compression of the left renal vein between the superior mesenteric artery and aorta.
• Symptoms include flank pain and hematuria, with traditional treatments being open surgery or stenting.
• This case highlights a rare presentation of nutcracker syndrome in a young woman.

Purpose of the Study:

• To describe the first laparoscopic splenic vein-left renal vein bypass for nutcracker syndrome.
• To demonstrate the feasibility and efficacy of this minimally invasive approach for complex vascular decompression.

Main Methods:

• A five-port transperitoneal laparoscopic approach was utilized.
• Intracorporeal suturing techniques were employed to anastomose the splenic vein to the left renal vein.
• Vascular control was maintained using laparoscopic bulldog clamps.

Main Results:

• The laparoscopic splenic vein-left renal vein bypass was successfully performed with a total warm ischemia time of 37 minutes.
• The anastomosis was watertight, and immediate improvement in venous outflow was observed.
• The patient experienced minimal blood loss, no complications, and significant symptom improvement.

Conclusions:

• Laparoscopic splenic vein-left renal vein bypass is a viable and effective treatment for nutcracker syndrome.
• This technique expands the application of laparoscopic surgery for complex urologic vascular conditions.
• Minimally invasive approaches offer a promising alternative for managing left renal vein compression.