The experience of using mini-invasive methods of pretransplant nephrectomy in children with end-stage kidney disease

Purpose. Our aim was to evaluate the endoscopic approach and the efficiency of pretransplant nephrectomy and nephro-ureterectomy in children with end stage kidney disease (ESKD). Materials and methods. We performed pre-transplant nephrectomies and nephro-ureterectomies in 12 children with ESKD and an average age of 8,3 years (11 months to 17 years old) using 3 - port prone-position, lateral retroperitoneal and transperitoneal laparoscopic approaches. The indications were vesico-ureteral reflux with persistent or recurrent urinary tract infection in 11 patients, uncontrolled hypertension in 1. Unilateral trans-peritoneoscopic nephro-ureterectomy was performed in 1 child and bilateral one in 3 patients with uretero-hydronephrosis. Bilateral nephrectomy was performed in 5 children with renal hypodysplasia and hydronephrosis; unilateral nephrectomy in 2, nephro-ureterectomy in 1. Results. 11 procedures were successfully performed. Conversion to open surgery was necessary in 1 case due to considerable sclerosis in paranephric body. One child developed a bleeding at postoperative period, which necessitated blood transfusion. Mean operative time was 72 min (35-95 min) for retroperitoneoscopic nephrectomy and 53 min (40-65 min) for transperitoneoscopic one. Peritoneal dialysis was initiated at a median of 8 hours after retroperitoneoscopic procedure and at a medium of 8 days after transperitoneoscopic one. Hemodialysis began in 1 day after both operations. Conclusions. Both laparoscopic approaches were safe, feasible and effective. Peritoneal dialysis may be initiated immediately after retroperitoneoscopic procedure that is vitally important in children with end stage kidney disease.

терминальная стадия хронической почечной недостаточности, предтрансплантационная нефрэктомия, нефро-уретерэктомия, лапароскопия, ретро-перитонеоскопия, дети, ESKD, pre-transplant nephrectomy, nephro-ureterectomy, laparoscopy, retro-peritoneoscopy, children

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