[Place of laparoscopic cysts decortication (LCD) in the treatment of autosomal dominant polycystic kidney disease (AD PKD)]. / Place de la résection laparoscopique des kystes rénaux pour polykystose rénale autosomique dominante symptomatique.

INTRODUCTION: Decortication of many cysts in patients with autosomal dominant policystic kidney disease (AD PKD) allows to reduce renal mass, decreases hydrostatic pressure in cysts; moreover it diminishes pain. METHODS: Between the years 2000-2005, 15 patients underwent laparoscopic cyst decortication (LCD) inculuding 5 (33.3%) men and 10 (66.7%) women. Patients age ranged between 41-73 years (mean 54 y.). Two patients underwent extraperitoneal and 13 transperitoneal LCD. In 2 patients were performed bilateral and in others unilateral decortication. LCD was done in 6 patients on the left side and in 7 on the right side. In all patients except three only 3 ports were used during these operations. Preoperative and postoperative diagnos was based on physical, laboratory, sonographic and computer tomografy (CT) examinations. Renal function was estimated by GFR and renal dynamic Tc99 scyntigraphy. Pain intensity was estimated in visual (VAS) 10 degree score. Follow-up after LCD was 9 to 77 months (mean 36 months). RESULTS: The mean operative time and the mean hospitalization time were respectively: 197 minutes and 5,4 days. The mean convalescence time was 10.5 days. The mean number of operated cysts was 43,5 per one patient. Pain was relieved in all (100%) patients into 6 months after LCD but has returned in 20% patients after 12 months and in 27% patients after 24 months. Hypertension regressed in 4 patients among 6 (40.0%) with high blood pressure before operation, but haematuria regressed in all patients among 5 (33.3%) with this symptom before LCD. The mean renal function (GFR) increase was observed about 10%, but blood purification in scitiscanning about 4.9% in all patients. CONCLUSIONS: (1) Laparoscopic cyst decortication (LCD) in patients with symptomatic AD PKD is safe, effective and repeatable alternative to non-radical open surgery. (2) LCD stabilizes renal function which together with improved renal perfusion and renal decontamination decreases number of severe, life-threatening complications.