Anuria Following Solitary Left Renal Vein Ligation: An Old Surgery Myth Is Rigorously Challenged

A consensus was established over the past several decades that left renal vein ligation, which is sometimes performed intraoperatively to improve surgical exposure and to control bleeding, was an innocuous and safe procedure. This surgical myth is primarily based on collateral venous pathways draining the left kidney post-ligation, with outcomes ranging from mild reversible transient renal dysfunction to no impact on renal function. Nevertheless, there have been some reports of transient renal failure and, rarely, irreversible end-stage renal disease following this procedure. We recently encountered post-operative anuria on post-operative day one with rapidly escalating serum creatinine that tripled in 24 hours and continued to rise. The patient soon started intermittent hemodialysis on post-operative day two and required a total of three alternate daily hemodialysis sessions before urine output returned. Hemodialysis was discontinued, and serum creatinine continued to decrease spontaneously thereafter. She was discharged home on post-operative day eight. Clearly, left renal vein ligation is not always a safe and innocuous procedure, more so in a patient with a single functioning left kidney. This is a call for increased caution and to limit this procedure or, otherwise, to consider vascular surgery repair and re-anastomosis of the ligated left renal vein, before wound closure.