Nefrectomía retroperitoneoscópica. Nuestra experiencia con ingreso en Hospital de Corta Estancia / Retroperitoneoscopic nephrectomy: our experience in sort hospital stay

RESUMEN

Objetivos. Demostrar que la nefrectomía, a pesar de ser un procedimiento de cirugía mayor, requiere una estancia hospitalaria menor de 48 horas, siempre que se realice mediante abordaje retroperitoneal laparoscópico. Consecuentemente este procedimiento puede ser realizado en el Hospital de Corta Estancia. Material y métodos. Desde 1995 hemos tratado 40 pacientes mediante nefrectomía retroperitoneoscópica con un total de 46 nefrectomías. En 6 pacientes fueron bilaterales por insuficiencia renal terminal (IRT), y por lo tanto no están reflejadas en este estudio. La edad media fue de 4,8 años (rango entre 6 meses y 13 años), con relación al sexo varones (n=16) y hembras (n=18). En cuanto al lado de la nefrectomía fue derecho en 20 e izquierdo en 14. Las patologías que indicaron nefrectomía(n=34) por anulación funcional del riñón fueron hidronefrosis obstructiva (n=2); megauréter obstructivo (n=1); nefropatía por reflujo vesicoureteral (n=8); displasia renal multiquística (n=11); riñón multiquístico desaparecido (n=12). Resultados. En todos los casos la nefrectomía fue retroperitoneal pura. El tiempo de duración quirúrgico medio fue de 92 min (rango de 60- 240 min). Se reconvirtió en 1 caso (4,5%) por microperforación peritoneal (n=1). Destacamos la ausencia de complicaciones inherentes al procedimiento retroperitoneoscópico intraoperatorio y postoperatorio. Como complicaciones secundarias al procedimiento quirúrgico se presentaron dos relajaciones de pared en herida incisional y un seroma de puerto de entrada. El sangrado durante el acto operatorio fue inapreciable, menor de 20 cc. No se dejaron drenajes en el lecho operatorio. La estancia media ha sido reducida a 27 horas, no siendo contabilizados los 6 casos de IRT. En los 18 últimos casos, el alta hospitalaria fue dada en las primeras 24 horas postoperatorias. La analgesia establecida por protocolo ha sido infiltración de puertos con bupivacaína 1% y una dosis de paracetamol/ibuprofeno a las 12 horas de la intervención, repetida al alta hospitalaria. La incorporación a su vida cotidiana –domicilio y escuela– ha sido precoz en el 100% de los casos. Destacamos la ausencia de complicaciones secundarias al dolor (respiratorias) y a la inmovilización. Conclusiones. La nefrectomía retroperitoneoscópica es una indicación claramente establecida y de obligada realización en la edad pediátrica. Es el abordaje quirúrgico idóneo para realizar una nefrectomía por su fiabilidad, reproducibilidad y seguridad. La estancia media se ha reducido con respecto a la cirugía convencional pudiéndose realizar en Hospital de Corta Estancia (AU)

ABSTRACT

Objective. To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. Material and methods. From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney’s functional annulations, were obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). Results. In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. Conclusions. The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stay is lesser when the nephrectomy was performed by retro peritoneal approach than conventional surgery. Consequently this procedure can be carry out in a short hospital stay Objective. To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. Material and methods. From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney’s functional annulations, were obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). Results. In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. Conclusions. The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stay is lesser when the nephrectomy was performed by retro peritoneal approach than conventionalsurgery. Consequently this procedure can be carry out in a short hospital stay (AU)