Bilateral laparoscopic nephrectomy with simultaneous peritoneal dialysis: a new era.

Peritoneal dialysis is the treatment of choice in children with end-stage renal failure who are awaiting renal transplantation. Traditionally patients requiring bilateral nephrectomy spent time on haemodialysis prior to being converted to peritoneal dialysis during a separate operation. Bilateral synchronous retroperitoneoscopic nephrectomy with the initiation of or return to peritoneal dialysis in the immediate postoperative period was performed on three patients with end-stage renal failure in our unit. The indications for bilateral nephrectomy were persistent heavy proteinuria in two children and difficult to control hypertension in the third. Bilateral laparoscopic nephrectomy was performed with the patients in the prone position. Two of the children were then placed in a supine position and a tunneled peritoneal dialysis catheter was inserted in the standard open fashion. The postoperative complications included a peritoneal catheter line breach requiring intraperitoneal antibiotics and a fever that was culture negative and settled spontaneously. This technique allows for immediate peritoneal dialysis, with the added benefit of reduced postoperative pain and improved cosmetic appearance.