Laparoscopic versus open nephrectomy for xanthogranulomatous pyelonephritis: An outcome analysis

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Pathology

Background:

• Xanthogranulomatous pyelonephritis (XGP) is a severe chronic infection of the kidney.
• Laparoscopic nephrectomy (LN) for XGP has been associated with high conversion and complication rates in prior literature.

Purpose of the Study:

• To compare the outcomes of open nephrectomy (ON) versus laparoscopic nephrectomy (LN) in patients with histopathologically confirmed XGP.
• To evaluate the safety and efficacy of LN in managing XGP.

Main Methods:

• Retrospective review of 37 patients with XGP treated between January 2001 and October 2009.
• Analysis of clinical presentation, preoperative course, intraoperative findings, postoperative recovery, and complications for both ON and LN groups.
• Statistical comparison using Student's t-test, with results expressed as mean ± standard deviation.

Main Results:

• 17 patients underwent LN and 20 underwent ON. One LN case required conversion due to dense adhesions and an ectopic pelvic kidney.
• Mean blood loss was significantly lower in the LN group (141.18 ± 92.26 ml) compared to the ON group (257.5 ± 156.67 ml).
• Mean hospital stay was shorter for LN (9.71 ± 4.55 days) versus ON (15.45 ± 7.35 days). Postoperative complication rates (Clavien Grade 2) were 29.4% for LN and 40% for ON.

Conclusions:

• Laparoscopic nephrectomy for XGP is feasible and offers benefits of minimally invasive surgery when performed by experienced surgeons in carefully selected patients.
• While challenging, LN can achieve comparable or better outcomes regarding blood loss and hospital stay compared to open nephrectomy for XGP.
• Careful patient selection and surgical expertise are crucial for successful laparoscopic management of xanthogranulomatous pyelonephritis.