Login to Access Video or Poster Abstract: MP23-14
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Introduction

During laparoscopic nephrectomy (LN), the renal artery and vein are traditionally dissected and ligated separately due to concern for increased risk of arteriovenous fistula (AVF) formation with en-bloc stapling of the renal hilum (EBSH). As the majority of data supporting this claim arises following nephrectomy for infectious and inflammatory conditions, we sought to evaluate the safety and efficacy of EBSH during LN for benign infectious and inflammatory renal conditions.

Methods

We performed a retrospective review of patients with benign inflammatory and infectious renal pathology undergoing LN using EBSH between 2008 and 2014 at three academic medical centers. Data analyzed included pathology, operative time, estimated blood loss (EBL), and perioperative or postoperative complications. Evaluation of AVF formation was assessed by postoperative imaging studies, physical exam (absence of abdominal bruit or palpable thrill), or evaluation of new onset diastolic hypertension.

Results

67 patients (mean age 55 +/- 16.2) underwent LN for a total of 71 renal units. EBSH was used in all cases (38 left renal units, 33 right renal units). Mean operative time was 174 min (range 84 to 373 min). Mean EBL was 150ml (range 20 ml to 2000 ml). One (1.8%) laparoscopic case was converted to open nephrectomy. The predominant pathology was obstruction in 23 (34.3%) and chronic infection in 23 patients (34.3%). Eleven (16.4%) patients had ESRD and 9 (13.4%) were on dialysis at the time of LN, with 4 (6.0%) patients going on to receive renal transplantation. No patients developed clinical or radiographic evidence of AVF at a mean follow-up of 14 months.

Conclusions

Ligation of the entire renal hilum with en-bloc stapling during LN is safe and effective. No patients in our cohort developed any significant immediate or intermediate term surgical complications or development of AVF as a result of en-bloc ligation. This study offers the largest cohort of en-bloc stapling in benign infectious and inflammatory kidneys to date, with no resulting radiographic or clinical diagnoses of AVF.

Funding

none