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Pretransplant bilateral nephrectomy and adjuvant operations

S P Wiehle, L H Banowsky, J J Nicastro-Lutton

    Urology
    |October 1, 1981
    PubMed
    Summary

    Transperitoneal bilateral nephrectomy offers a viable alternative when the posterior approach is not feasible, showing comparable outcomes for patients needing concurrent surgeries. Careful surgical care and understanding of hemodialysis patient needs minimize risks.

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    Area of Science:

    • Nephrology
    • Surgical Oncology
    • Transplant Surgery

    Background:

    • The posterior approach for pretransplant bilateral nephrectomy is associated with low morbidity and mortality.
    • This approach is not suitable for all patients, including those with polycystic renal disease or those requiring simultaneous intraperitoneal procedures.

    Purpose of the Study:

    • To evaluate the safety and efficacy of transperitoneal bilateral nephrectomy in patients requiring concurrent adjuvant operations.
    • To compare morbidity and mortality rates of transperitoneal bilateral nephrectomy with the posterior approach.

    Main Methods:

    • A retrospective review of 34 patients who underwent transperitoneal bilateral nephrectomy.
    • Analysis of 29 concurrent adjuvant operations performed alongside the nephrectomy.

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  • Comparison of outcomes with historical data for posterior bilateral nephrectomy.

    • Main Results:

    • Morbidity and mortality rates for transperitoneal bilateral nephrectomy were comparable to those reported for the posterior approach.
    • Successful completion of 29 concurrent adjuvant operations, including splenectomy and vagotomy/pyloroplasty.
    • Outcomes were attributed to meticulous surgical principles and tailored perioperative care for hemodialysis patients.

    Conclusions:

    • Transperitoneal bilateral nephrectomy is a safe and effective alternative for patients unsuitable for the posterior approach, especially when combined with other intraperitoneal surgeries.
    • Careful perioperative management is crucial for minimizing complications in patients undergoing this procedure, particularly those on chronic hemodialysis.