[Complications and mortality after radical nephrectomy in a low-volume hospital.] / Complicaciones y mortalidad tras nefrectomía radical en un hospital de bajo volumen quirúrgico.

OBJECTIVES: To evaluate the complications and 30-day mortality rates following open radical nephrectomy and laparoscopic radical nephrectomy using the Clavien-Dindo classification system in a low-volume hospital. METHODS: We conducted a retrospective analysis of 263 patients who underwent open or laparoscopic radical nephrectomy (1996-2016) in our local district general hospital. Postoperative complications and 30- day mortalities were evaluated using the Clavien-Dindo classification. The predictors of postoperative complications were assessed using multivariate logistic regression analysis. RESULTS: We found that, compared to open radical nephrectomy, laparoscopic resulted in a significantly longer operative time (112.6±41 vs 199.3±61 minutes, p <  0.01) and a shorter hospital stay (8.5±2.4 vs 5.7±3 days, p < 0.001). The most common complications were bleeding or hematoma (4.9%) and problems associated with the wound (4.5%). There were no significant differences between the ORN and LRN groups in terms of complications based on the Clavien-Dindo classification. On multivariate analysis, a longer operative time (Odds Ratio, 1.009; 95% confidence interval, 1.002- 1.015; p = 0.010) and higher body mass index (Odds Ratio, 0.898; 95% confidence interval, 0.822-0.981; p = 0.017) were found to be significant predictors of complications after nephrectomy. CONCLUSIONS: Our study demonstrated that complication and 30-day mortality rates were low. There was a greater number of low-grade complications, and there were no significant differences in these rates between open and laparoscopic radical nephrectomy. A longer operative time and a higher BMI were predictors of possible complications. We provide additional evidence to support the feasibility of performing open or laparoscopic radical nephrectomy in low-volume hospitals.

OBJETIVOS: Evaluar la tasa de complicaciónes y mortalidad a 30 días después de nefrectomía radical abierta o laparoscópica utilizando el sistema de clasificación Clavien-Dindo en un hospital de bajo volumen quirúrgico.MÉTODOS: Realizamos un análisis retrospectivo de 263 pacientes a los que se les practicó nefrectomía radical laparoscópica o abierta (1996-2016). Las complicaciones postoperatorias y la mortalidad a 30 días fueron evaluadas utilizando la clasificación de Clavien-Dindo. Analizamos los factores predictores de complicaciones postoperatorias mediante análisis multivariado con regresión logística. RESULTADOS: Comparado a la nefrectomía abierta, la nefrectomía radical laparoscópica resultó en un mayor tiempo quirúrgico (112,6±41 vs 199,3±61 minutos, p < 0,01) y una menor estancia hospitalaria (8,5±2,4 vs 5,7±3 días, p <  0,001). Las complicaciones más frecuentes fueron sangrado o hematoma (4,9%) y problemas asociados a la herida (4,5%). No hubo diferencias significativas entre cirugía abierta o laparoscópica evaluando las complicaciones mediante la clasificación de Clavien-Dindo. En el análisis multivariado, un tiempo quirúrgico prolongado (Odds Ratio, 1.009; 95% intervalo de confianza, 1.002-1.015; p = 0,010) y un mayor índice de masa corporal (Odds Ratio, 0,898; 95% intervalo de confianza, 0,822-0,981; p = 0,017) fueron predictores significativos de complicaciones. CONCLUSIONES: Nuestro estudio muestra que la tasa de complicaciones y mortalidad a 30 días fueron bajas, con un mayor número de complicaciones de bajo grado y sin diferencias significativas entre cirugía abierta o laparoscópica. Un tiempo quirúrgico prolongado y mayor índice de masa corporal fueron predictores de posibles complicaciones. Aportamos evidencia adicional apoyando la realización de nefrectomía radical laparoscópica o abierta en hospitales de bajo volumen quirúrgico.

Chylous ascytis causing abdominal distension after laparoscopic radical nephrectomy.

OBJECTIVE: To report a case of large chylous ascytis as a late complication of a laparoscopic nephrectomy for renal tumor. METHODS: A 62 year old patient was admitted with general deterioration and abdominal distension due to chylous ascites. Abdominal ultrasound and CT led to the diagnosis. Paracentesis confirmed the presence of a large peritoneal chylous fluid effusion. RESULTS: The patient was treated by punction and placement of a percutaneous drainage. A large amount of lymphatic fluid was obtained after punction with a progressive decrease. Medical treatment included low sodium and low fat diet, together with medium chain fast absorbing triglycerides, protein supplements, diuretics and somatostatin analogues (octeotride). The patient's progress was satisfactory after several days of treatment. CONCLUSIONS: Chylous ascites is a rare complication of laparoscopic nephrectomy, but it has a favorable course if managed conservatively. Meticulous clipping of the retroperitoneal lymph vessels is recommended to prevent the formation of chylous ascites, especially when discharging the renal vascular pedicle during nephrectomy or extensive lymphadenectomy.

Testicular reconstruction after testicular rupture and review of the literature.

OBJECTIVE: To report a clinical case of testicular rupture and review of the literature published. METHOD: A 15 years old male with a testicular rupture after a sports injury was diagnosed by Doppler ultrasound. RESULTS: Surgical exploration was performed and the tear was repaired. He had a benign postoperative course. The patient presents a normal size testicle after a year of follow-up. CONCLUSIONS: Testicular rupture is an uncommon but important entity that may occur. It is essential early diagnosis and e management to avoid orchiectomy.