Results

Nephropexy is one of the oldest surgical procedures performed for symptomatic nephroptosis. Nevertheless, there is a continuing debate with regard to the indication and necessity of this procedure. Earlier, limited diagnostic studies prevented careful selection of patients with respect to the exclusion of other nonurological causes. With the advent of intravenous urography, a better understanding of this complex disorder

FIGURE2 ■ Placement for the retroperitoneal approach.

The laparoscope can be inserted within the inflated transparent balloon to confirm appropriate balloon placement and adequate expansion of the retroperitoneum.

During insertion of the third port, care must be taken to prevent breaching of the peritoneum. If required, the lateral reflection of the peritoneum can be further mobilized anteromedially before the port is inserted.

TABLE 1 ■ Worldwide Experience with Laparoscopic Nephropexy

Number

Follow up

Study

Year

of patients

Approach

Fixation

(months)

Results

Hubner

1994

10

Transperitoneal

Polygactin

1-9

100%

et al.

net

Asymptomatic

Elashry

1995

6

Transperitoneal

Quadratus

2-30

100%

et al.

lumborum

Asymptomatic

Fornara

1997

23

Transperitoneal

Psoas/

12-27

91%

et al.

quadratus lumborum

Asymptomatic

McDougall

2000

14

Transperitoneal

Quadratus

4-75

80%

et al.

lumborum

Asymptomatic

Rassweiler

2001

31

Retroperitoneal

Psoas muscle

24 (mean)

83%

et al.

Asymptomatic

Plas et al.

2001

13

Transperitoneal

Polypropylene net

63-93

92% Asymptomatic

Chueh

2002

23

Retroperitoneal

Psoas/

2-84

84%

et al.

quadratus lumborum

Asymptomatic

Ichikawa

2003

5

Retroperitoneal

Psoas/

5-22

80%

et al.

quadratus lumborum

Asymptomatic

Overall, about 130 patients with symptomatic nephroptosis have been treated laparoscopically. The transperitoneal approach seems to be favored over the retroperitoneal approach.

Early postoperative results after laparoscopic nephropexy vary from 80% to 100% success rate after one year and complete relief of symptoms in most cases. Long-term results up to five years following laparoscopic nephropexy showed complete remission in the vast majority of patients.

with associated functional changes could be demonstrated. As a result, nephropexy became established as the treatment of choice for symptomatic nephroptosis.

Overall, about 130 patients with symptomatic nephroptosis have been treated laparoscopically. The transperitoneal approach seems to be favored over the retroperi-toneal approach.

Laparoscopy has brought to the surgical realm a minimally invasive method of approaching surgical problems with certain advantages over conventional open surgery. With the advent of intracorporeal suturing, reconstructive procedures have begun to come into the realm of minimally invasive therapy. Various authors have reported their experiences with laparoscopic nephropexy over the last decade (11-20). Table 1 summarizes all the reported series of laparoscopic nephropexy in the English literature.

Success of the surgery is usually defined as resolution of the symptoms associated with nephroptosis. Postoperative intravenous urogram assessment should reveal minimal descent of the kidney in majority of the patients. In additional, the ureteral obstruction associated with the kidney ptosis should also be resolved.

Early postoperative results after laparoscopic nephropexy vary from 80% to 100% success rate after one year and complete relief of symptoms in most cases. Long-term results up to five years following laparoscopic nephropexy showed complete remission in the vast majority of patients (18,19).

Few cases of symptomatic recurrence were observed after the initial success (18). Nonabsorbable materials (suture or mesh) should be used for the fixation of the mobile kidney to the retroperitoneum muscles. After concluding that the use of absorbable polygactin mesh for fixation was responsible for the recurrences seen, the authors subsequently changed to nonabsorbable polypropylene mesh, and no further symptomatic recurrences were noted.

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