Background:
Retroperitoneal laparoscopic nephropexy has been applied to nephroptosis. We
investigate the approach and treatment effect of retroperitoneal laparoscopic
nephropexy. Methods: From May 1990 to October 2013, 45 patients with
nephroptosis treated in our hospital were retrospectively analyzed. Among them,
25 patients underwent nephropexy (open surgery group), the other 20 patients
underwent retroperitoneal laparoscopic nephropexy (laparoscopic surgery
group). In open surgery group, there were 24 females and 1 male, aged 20 -
35 years. In laparoscopic surgery group, there were 19 females and 1 male, aged
20 - 35 years. All of them with nephroptosis of the right kidney were
combined with lower back pain or hematuria and underwent intravenous
pyelography (IVP) and color ultrasound in orthostatic and supine
position for a specific diagnosis. In open surgery group, patients underwent
open surgery. Their kidneys were fully dissociated, then, the upper
and middle pole of the dorsal kidney
was sutured with lumbar fascia for two stitches for
fixation respectively. While in laparoscopic surgery group, kidneys
were fully dissociated in Gerota’s fascia during laparoscopic surgery,
and the upper pole of the dorsal kidney was sutured with
the lumbar fascia for two stitches using a 2-0 absorbable
suture. They were all in the supine position for a week after
surgery. The body mass index (BMI), operation time, bleeding amount, postoperative
hospital stay, wound complication rate and other indicators were compared
between two groups. Results: BMI in open surgery group was 16.77 ± 0.80
kg/m2, BMI in laparoscopic surgery group was 16.73 ± 0.78 kg/m2, P >
0.05 showed no statistical difference; the operation time in open surgery group
was 70.96 ± 10.61 min, that in laparoscopic surgery group was 34.65 ± 4.87
min, P < 0.001 showed highly statistical significance; the
bleeding amount in open surgery group was 20.65 ± 6.48 ml, that in laparoscopic
surgery group was 4.85 ± 1.63ml, P < 0.001 showed highly
statistical significance; the postoperative hospital stay in open surgery group
was 7.54 ± 1.28 d, that in laparoscopic surgery group was 7 d, P >
0.05 showed no statistical difference. In open surgery group, four patients
had wound infection which delayed the healing, and the wound complication
rate was 16% (4/25). In laparoscopic surgery group, wound complications
did not appear, the incidence was 0%, X2 = 1.8144, P >
0.05 showed no statistical difference. The mean follow-up visit lasted 1.5
years after surgery (3 months to 2 years), B-mode ultrasound in orthostatic and
supine position showed kidneys were in the normal position. Compared with those
before surgery, postoperative uncomfortable symptoms completely disappeared in
all patients. Conclusions: Retroperitoneal laparoscopic nephropexy has a good
effect on symptomatic nephroptosis. The two stitches of suture
between the upper pole of the dorsal kidney and the lumbar fascia
show convenient operation, less damage and faster postoperative
recovery, which are better than open surgery.