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Laparoscopic nephrectomy in children: Does the approach matter?

Osama M Sarhan1

  • 1Mansoura Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

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Summary

Retroperitoneal laparoscopic nephrectomy (RPLN) in children offers advantages over transperitoneal laparoscopic nephrectomy (TPLN), including less blood loss and shorter hospital stays. Both approaches are safe and effective for pediatric kidney removal.

Keywords:
ComplicationLaparoscopyNephrectomyPediatric kidneyRetroperitonealTransperitoneal

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Area of Science:

  • Pediatric Surgery
  • Minimally Invasive Surgery
  • Urology

Background:

  • Laparoscopic nephrectomy (LN) is a standard procedure for benign non-functioning kidneys in children.
  • The transperitoneal (TP) and retroperitoneal (RP) approaches are two common methods for pediatric LN.

Purpose of the Study:

  • To compare the safety and efficacy of the TP and RP approaches for laparoscopic nephrectomy in pediatric patients.
  • To evaluate outcomes such as operative time, complications, and recovery metrics.

Main Methods:

  • A retrospective study of 79 pediatric patients who underwent LN between 2007 and 2019.
  • Patients were divided into two groups: 41 undergoing TP approach (TPLN) and 38 undergoing RP approach (RPLN).
  • Comparison focused on operative time, blood loss, complications, oral intake resumption, analgesia, and hospital stay.

Main Results:

  • Successful LN was achieved in 75 out of 79 cases, with 4 conversions to open surgery (3 TPLN, 1 RPLN).
  • Significant differences favoring RPLN were observed in estimated blood loss (p=0.013), time to resume oral intake (p=0.001), and postoperative hospital stay (p=0.024).
  • No significant differences were found in operative time, overall complication rates, or need for postoperative analgesia.

Conclusions:

  • Both TP and RP approaches are safe and effective for pediatric laparoscopic nephrectomy.
  • The RP approach demonstrates advantages regarding reduced intraoperative blood loss, faster resumption of oral intake, and shorter hospital stays.