RESUMEN
OBJECTIVE: To present the results of our case series on laparoscopic nephrectomy in xanthogranulomatous pyelonephritis (XGP). METHODS: A retrospective study was conducted that included 143 patients treated with laparoscopic nephrectomy for non-functioning kidney, of whom 15 had XGP, within the time frame of 2011 to 2019. The demographic and clinical data were collected, along with the intraoperative results, complications, and days of hospital stay. RESULTS: Transperitoneal laparoscopic nephrectomy was successfully performed on 15 patients with XGP, with no need for conversion. Mean intraoperative time was 124.4 minutes (range 70-240) and intraoperative blood loss was 148.5 ml (range 30-550), with no blood transfusion required. No intraoperative complications occurred but there was one postoperative complication (6.6%), classified as Clavien-Dindo I (surgical wound infection). Mean hospital stay was 2.85 days (range 2-7). CONCLUSIONS: Nephrectomy is the definitive management for XGP, and the laparoscopic approach should be considered a treatment modality, despite the fact that the pathology involves a severe chronic inflammatory process. Its benefits are reduced surgery duration, less blood loss, a lower complication rate, and fewer days of hospital stay, when performed by a skilled and experienced surgeon.
OBJETIVO: Presentar los resultados de nuestra serie de nefrectomía laparoscópica en pielonefritis xantogranulomatosa (PXG). MÉTODO: Se realizó un estudio retrospectivo que incluyó 143 pacientes tratados con nefrectomía laparoscópica por exclusión renal, de los cuales 15 fueron por PXG, en el periodo comprendido de 2011 a 2019. Se recolectaron datos demográficos y clínicos, resultados transoperatorios, complicaciones y días de estancia hospitalaria. RESULTADOS: Se realizó nefrectomía laparoscópica transperitoneal de forma exitosa en 15 pacientes con PXG, sin necesidad de conversión. El tiempo transoperatorio promedio fue de 124.4 minutos (rango: 70-240). El sangrado transoperatorio fue de 148.5 ml (rango: 30-550), sin requerimiento de transfusión sanguínea. No se reportaron complicaciones transoperatorias; se presentó una complicación en el posoperatorio (6.6%) clasificada como Clavien-Dindo I (infección de la herida quirúrgica). La estancia hospitalaria promedio fue de 2.85 días (rango: 2-7). CONCLUSIONES: El manejo definitivo de la PXG es la nefrectomía, y el abordaje laparoscópico debe ser considerado como una modalidad de tratamiento a pesar de ser una patología que presenta un proceso inflamatorio grave y crónico, obteniéndose beneficios como disminución en el tiempo quirúrgico, menor sangrado, menor tasa de complicaciones y menos días de estancia hospitalaria cuando es realizado por un cirujano experimentado.
Asunto(s)
Laparoscopía , Pielonefritis Xantogranulomatosa , Humanos , Estudios Retrospectivos , Laparoscopía/métodos , Pérdida de Sangre Quirúrgica , Complicaciones Intraoperatorias/cirugía , Nefrectomía/métodos , Pielonefritis Xantogranulomatosa/cirugíaRESUMEN
OBJECTIVE: To compare the perioperative results of adult and elderly patients undergoing laparoscopic renal surgery. METHODOLOGY: Retrospective, analytical study. 448 who underwent kidney surgery for benign or malignant pathologies between 2011-2019 were included in the General Hospital of Mexico "Dr. Eduardo Liceaga". They were categorized into two groups: Group 1 <60 years and Group 2 >60 years. Descriptive statistics and bivariate analysis were performed, the calculations were performed with 95% reliability and a value of p (<0.05). RESULTS: In the group over 60 years of age, the following was found: Age: 67.1 years (60-83). IMC 28.3 kg/m2 (19-48.7). Intra and postsurgical outcomes: intraoperative bleeding = 184.4cc (5-1700). Surgical Time = 112.6min (30-240). Days of hospital stay = 2 (1-7). Complications in 2.6% (Clavien-Dindo: I = 2; II = 1), no conversion was required in any patient. There were no statistically significant differences with group 1, an exception for intraoperative bleeding. CONCLUSIONS: Our study is a pioneer in Latin America in the evaluation of the geriatric population and outcomes with laparoscopic surgery and we recommend that renal procedures with a laparoscopic approach should be considered as the best strategy in the management of benign or malignant renal pathology in geriatric patients.
