Laparoscopic nephropexy for symptomatic nephroptosis: initial experience

ABSTRACT

To evaluate the efficacy of laparoscopic nephropexy as a minimally invasive procedure for treatment of cases with symptomatic nephroptosis. We have performed laparoscopic right nephropexy in 6 patients presenting with symptomatic nephroptosis documented by radiographic studies [IVU] and/or renal scans. Exposure of the kidney was achieved via a transperitoneal laparoscopic approach. For kidney fixation, the upper most part of the lateral border of the kidney was sutured to the overlying fascia of the quadratus lumborum muscle using ah intracorporeal suturing technique. In addition, the mid-portion of the renal capsule was sutured to the back muscle and its covering fascia using two or three running sutures thereby, creating a vertical and horizontal means of fixation. Laparoscopic right nephropexy was successfully accomplished in all 6 patients. The average operative time was 4 hours. All patients resumed oral intake during the first postoperative day; the average amount of parenteral analgesia required postoperatively was 42.7 mg of morphine sulphate or its equivelant. Hospital stay averaged 2.5 days; return to usual activities occurred on average at 2.5 weeks postoperatively. Postoperative imaging studies confirmed reduction or elimination of nephroptosis in all patients; all patients have remained asymptomatic during an average follow-up of 19 months [range 3 to 33 months]. Laparoscopic nephropexy appears to be a feasible minimally invasive treatment option for patients with symptomatic, documented nephroptosis. It can be safely and effectively accomplished with satisfactory anatomical and clinical results: