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Laparoscopic Left Renal Vein Transposition for Nutcracker Syndrome: A Single-Center Case Series
Paulina Mizera1, Jacek Cywiński2, Michał Pająk1
1Department of Vascular Surgery, Copernicus Memorial Multispecialty Centre for Oncology and Traumatology, Lodz, Poland.
Background:
Nutcracker syndrome is a rare vascular compression disorder caused by entrapment of the left renal vein, most commonly between the aorta and the superior mesenteric artery. Surgical treatment is reserved for patients with persistent and debilitating symptoms; however, evidence regarding minimally invasive approaches remains limited. This study aimed to evaluate the outcomes of laparoscopic left renal vein transposition in patients with symptomatic nutcracker syndrome.
Methods:
A retrospective analysis was conducted of nine consecutive patients who underwent laparoscopic left renal vein transposition for symptomatic nutcracker syndrome between 2019 and 2024 at a single tertiary vascular center. Diagnosis was established using contrast-enhanced computed tomography demonstrating significant left renal vein compression. Perioperative outcomes, complications, length of hospital stay, and clinical symptom resolution during follow-up were assessed.
Results:
The study group included seven women (77.8%) and two men (22.2%), aged 20-52 years. The most common presenting symptom was left flank or lumbar pain. All procedures were completed laparoscopically without conversion to open surgery. Operative time ranged from 180 to 375 minutes, with a median hospital stay of 4 days. One patient experienced major perioperative bleeding requiring transfusion and pleural drainage (Clavien-Dindo IIIb). Most patients achieved complete or substantial symptom relief during follow-up. One patient developed late anastomotic occlusion with symptom recurrence requiring reoperation and venous bypass reconstruction.
Conclusions:
Laparoscopic left renal vein transposition appears to be a safe and effective treatment option for selected patients with symptomatic nutcracker syndrome. The minimally invasive approach provides favorable clinical outcomes with acceptable perioperative morbidity; however, long-term follow-up remains essential because of the risk of anastomotic occlusion and symptom recurrence. Further multicenter studies with larger patient cohorts are required to better define optimal treatment strategies.
