PURPOSE: We report our experience with laparoscopic heminephrectomy (LH) in children with duplex kidneys, emphasizing complications and late outcomes, and including anatomic and functional aspects. PATIENTS AND METHODS: We retrospectively reviewed medical data of 28 children with a duplex kidney who underwent LH. Complications were evaluated according to the Savata and Clavien classiffication systems. RESULTS: Nineteen upper (67.8%) and 9 (32.1%) lower moieties were removed. All laparoscopic procedures were completed as planned without conversion. There were three (10.5%) cases of intraoperative bleeding successfully controlled by compression with gauze. Complications after surgery included two urinomas (7%), one intra-abdominal hematoma (3.5%), and two cases of complete functional loss (7%) because of torsion of the remnant upper pole. In six (21.4%) cases, a cyst at the resection margin of the kidney remnant was found. The function of the remnant pole was preserved in 23 (82.1%) cases and decreased in approximately 5% in 3 (10.5%). CONCLUSIONS: The anatomic and functional outcomes of LH must be evaluated with imaging studies and nuclear scintigraphy to rule out structural abnormalities and functional impairment. An extensive dissection in the lower pole LH can lead to the upper moiety torsion after surgery.
PURPOSE: We report our experience with laparoscopic heminephrectomy (LH) in children with duplex kidneys, emphasizing complications and late outcomes, and including anatomic and functional aspects. PATIENTS AND METHODS: We retrospectively reviewed medical data of 28 children with a duplex kidney who underwent LH. Complications were evaluated according to the Savata and Clavien classiffication systems. RESULTS: Nineteen upper (67.8%) and 9 (32.1%) lower moieties were removed. All laparoscopic procedures were completed as planned without conversion. There were three (10.5%) cases of intraoperative bleeding successfully controlled by compression with gauze. Complications after surgery included two urinomas (7%), one intra-abdominal hematoma (3.5%), and two cases of complete functional loss (7%) because of torsion of the remnant upper pole. In six (21.4%) cases, a cyst at the resection margin of the kidney remnant was found. The function of the remnant pole was preserved in 23 (82.1%) cases and decreased in approximately 5% in 3 (10.5%). CONCLUSIONS: The anatomic and functional outcomes of LH must be evaluated with imaging studies and nuclear scintigraphy to rule out structural abnormalities and functional impairment. An extensive dissection in the lower pole LH can lead to the upper moiety torsion after surgery.
Authors: Ciro Esposito; Maria Escolino; Marco Castagnetti; Antonio Savanelli; Angela La Manna; Alessandra Farina; Francesco Turrà; Agnese Roberti; Alessandro Settimi; Francois Varlet; Holger Till; Jean Stephan Valla Journal: Transl Pediatr Date: 2016-10