Pretransplant bilateral nephrectomy and adjuvant operations

Pretransplant bilateral nephrectomy by the posterior approach has been associated with minimal morbidity and mortality. Unfortunately the posterior approach is not applicable to all patients, e.g., patients with polycystic renal disease or patients who need simultaneously another intraperitoneal adjuvant operation such as splenectomy or vagotomy and pyloroplasty. This article presents 34 patients who had a transperitoneal bilateral nephrectomy and 29 other concurrent adjuvant operations. Morbidity and mortality are comparable to that reported for simple bilateral nephrectomy performed posteriorly. The reduction in morbidity and mortality was believed to be due to a careful application of the basic principles of surgical care and an appreciation of the special problems posed by patients on chronic hemodialysis. Perioperative care will be discussed in detail.