Laparoscopic vs. Open nephrectomy for inflammatory renal conditions: a meta-analysis emphasizing safety

Nephrectomy for inflammatory renal conditions (IRCs) presents comparable challenges irrespective of the surgical approach. This meta-analysis evaluates whether laparoscopic nephrectomy (LN) is safer than open nephrectomy (ON) for managing IRCs, including xanthogranulomatous pyelonephritis (XGP), pyonephrosis, and renal tuberculosis.

Following PRISMA/Cochrane guidelines, we systematically reviewed studies comparing LN and ON in adults with IRCs. Inclusion required direct LN vs. ON comparisons and perioperative outcomes. Exclusions included pediatric cohorts and studies conflating converted LN cases with ON groups.

From 16 identified studies, 13 met the inclusion criteria, encompassing 868 patients undergoing nephrectomy for IRCs. Of these, 398 (45.9%) underwent ON, and 470 (54.1%) underwent LN. Compared to ON, LN demonstrated a statistically significant (28%) reduction in overall-complications (RR = 0.72, 95% CI [0.6-0.86]; p = 0.0004; low-heterogeneity) and non-significant reduction in high-grade complications (RR = 0.65, 95% CI [0.4-1.06]; p = 0.09; low-heterogeneity), with moderate certainty of evidence. LN was also associated with 53% fewer blood transfusions (post-sensitivity analysis (RR = 0.47, p < 0.0001; low certainty), significant blood loss reduction in XGP-patients (after subgroup analyses MD = -130.8 mL; 95% CI [-203.35 to -58.21]; low certainty), and shorter hospital stays (PMD = -3.04 days; p < 0.00001; very low certainty), albeit with longer operative times (PMD = + 39.05 min; p = 0.03; very low certainty).

LN is a safer alternative to ON for IRCs, offering fewer complications, shorter hospitalization, and reduced transfusions despite prolonged operative times. Surgeon expertise and patient-specific selection are critical to optimizing outcomes.