Extracorporeal renal surgery

By means of techniques derived mainly from renal transplant surgical experience, several pathologic conditions of the renal artery, the kidney and the ureter have been made accessible to surgical therapy in the course of the past two decades. This therapy is basically composed of nephrectomy, workbench surgery and reimplantation of the kidney, in this order, and called "extracorporeal renal surgery'. Indications for its use are proposed and discussed, and the operative technique is described. Results are presented of 27 extracorporeal vascular reconstructions in 25 patients with severe renovascular hypertension on the basis of fibromuscular dysplasia located predominantly peripherally in the renal artery and its branches. Of these procedures, 25 were actually completed since in two patients reconstruction of the renal artery was technically impossible and reimplantation of their kidneys had to be discarded. One out of the other 23 patients died because of haemorrhagic and septic complications. In the remaining group of 22 patients, operation-associated complications were observed in one patient, who had to be reoperated because of bleeding at the operation site. At a mean follow-up period of 4.5 years, all these 22 patients had normal blood pressures, and 16 were off medication ("cured') whereas six needed only moderate anti-hypertensive medication ("improved'). Results are also presented of extracorporeal procedures performed in one patient with a carcinoma in a solitary kidney and in one patient with a ruptured aneurysm of the abdominal aorta in which both renal arteries were involved. Both patients are well at one and more than five years postoperatively, respectively.