Laparoscopic Nephrectomy in Patients with Previous Abdominal Surgery

Abstract

Laparoscopic nephrectomy is a minimally invasive procedure that provides significant benefits to the patient, such as reduced analgesic requirements and shorter recovery time. While the popularity of laparoscopy has grown substantially, there are associated risks of injury to the blood vessels and/or viscera during the insertion of the laparoscopic ports. Such injuries can lead to a significant increase in mortality rates. Patients who have had previous abdominal surgery have a higher risk of adhesions; this has been shown to increase the risk of complications from port placement. Consequently, previous abdominal surgery was viewed as a relative contraindication to laparoscopic surgery. However, studies have demonstrated the advantages of laparoscopic surgery over an open radical approach; hence, previous abdominal surgery is no longer viewed as a contraindication. Here, we describe the case of a 62-year-old man who presented with an incidental finding of right renal cell carcinoma (RCC). We performed a radical nephrectomy on this patient who had undergone multiple previous abdominal surgeries. During this procedure, a small bowel injury occurred. Herein, we review the available evidence and describe the risk factors and techniques to avoid injury from laparoscopic port-site placement in patients undergoing nephrectomy with a history of previous abdominal surgery.

Nephrectomy indications in kidney diseases: 10-years’ experience study

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peri-nephric adhesions [1][2][3][4][5]. Zelhof et al have sugges ted that the term "simple" should be changed to "benign" based on observation of raised complications for benign conditions when compared with radical nephrectomy database [1].The rate of nephrectomy for simple indications has been declining in developed countries because of early detection and treatment, however, a large proportion of cases still land up with nephrectomy in our locality.

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“…peri-nephric adhesions [1][2][3][4][5]. Zelhof et al have sugges ted that the term "simple" should be changed to "benign" based on observation of raised complications for benign conditions when compared with radical nephrectomy database [1].…”