Open and laparoscopic kidney nephropexy: indications, operation, postoperative period

Discovered by any methods of research( instrumental) omission of the kidney, which is called nephroptosis, absolutely not disturbing the patient can be treated in a conservative way. If the mobility of the kidney exceeds the permissible range of its displacement and is accompanied by sharp pains in the abdomen or in the lumbar region, nausea, frequent inflammatory processes, then one should think about surgery. There is an effective surgical method for treating nephroptosis called nephropexy.

Nephropexia

Nephropexy is a method of surgical intervention for the pathological mobility of the kidney with reliable fixation in the renal bed. It is very important that the kidney remains physiologically mobile along the vertical axis and along its perimeter.

There are two methods of operative nephropexy:

1. Kidney fixation by laparoscopy;
2. Nephropexy through open access.

Indications and contraindications

Quite often people with excessive mobility of the kidneys do not complain about anything, that is, nephroptosis does not have any clinical manifestations. This suggests that the functioning of the urinary system is not violated. In this case, surgery is not required.

There are a number of conditions, the occurrence of which is a direct indication for nephropexy:

1. Pain syndrome, which is characterized by sharp or aching pains in one or both sides, in the abdomen, lower back.
2. Frequent development of inflammation in the kidneys( pyelonephritis).
3. Nephroptosis can be the main cause of urolithiasis.
4. Transformation of the kidneys by the type of hydronephrosis.
5. Systematic rises in the level of blood pressure( vasorenal hypertension).
6. Development of kidney failure.

Contraindicated surgery in such cases:

1. Functionally decompensated heart disease and vascular pathology;
2. Splanchnotosis( omission of internal organs);
3. Any inflammatory disease in the patient's body;
4. Diabetes mellitus.
5. Significant decrease in hemoglobin level in the blood and concentration of red blood cells - erythrocytes called anemia.

For the surgical intervention the patient's body requires careful preparation, it is necessary to achieve normalization of all laboratory parameters and only after that to begin nephropexy.

Preparing for operation

Before going to an operation for nephroptosis, it is necessary to undergo a set of instrumental and laboratory examinations prescribed by the treating doctor, to achieve complete normalization of urine and blood counts. In the preoperative period, excretory urography should be performed( to determine and visualize the level of obstruction, if any), remove the electrocardiogram, draw urine and blood for a general analysis, examine the biochemical parameters of the blood and liver tests.

Nephropexy

Nephropexy, which is performed through open operative access, involves cutting out a flap of the lumbar muscle and holding it under the kidney capsule with simultaneous fixation.

On the posterior surface of the kidney, at the middle of its longitudinal dimension, the capsule is dissected, bluntly separated from the kidney itself, forming a tunnel. Then an incision is made at the level of the lower pole of the kidney and the capsule is cut off towards the upper pole of the kidney, only along the front surface. The result is an artificially formed tunnel in the form of a hook( between the kidney and its capsule) into which the prepared flap of the lumbar muscle is placed and fix it. Thus, the artificial bed holds the organ well.

This method is more traumatic than laparoscopic nephropexy.

Laparoscopic nephropexy. This surgical intervention can be performed by introducing the patient into a state of general anesthesia and under an epidural blockade. The surgeon produces the first percutaneous puncture and inserts a laparoscope into the abdominal cavity, after which air is injected. The kidney is separated from the surrounding tissues( mobilization).Then, for the introduction of other tools, two more punctures are made next. The kidney is stitched with a needle in the form of a hook, it is fixed to the fibers of a square lumbar muscle.

The advantages of this type of operation are that the surgical wound is small, postoperative recovery is carried by the patient much easier and faster than with the open surgery. Also, the risk of infection is much lower.
On video, performing laparoscopic nephropexy:

Postoperative period

The period after open access surgery is somewhat more severe than after laparoscopic, intensive pain syndrome and symptoms of general intoxication are noted. After nephropexy with a laparoscope, patients the next day can already get up on their feet without feeling pain. Immediately after the intervention, as soon as they leave the anesthesia, they usually complain of severe chills and aching pain in the area of ​​the operating wound, but this lasts about 6-7 hours. Walking on small distances is allowed as early as the day after the operation, but intensive physical exertion, transportation and flights should be postponed for a while. Sports can be restarted after 6 months and only after a control ultrasound of the genitourinary system and contrast urography( intravenous).

In inpatient treatment after open surgery, the patient should stay at least 3 weeks while rehabilitation lasts, and after laparoscopic - 1 week.

For the first days, the patient must comply with bed rest and lie with his legs elevated( relative to the trunk the legs should be 20 cm higher).During emptying the intestine can not strain.

Complications and forecasts

In the event of some difficulties during the operation itself or because of unfair performance of the doctor's recommendations in the postoperative period, such complications may develop:

1. A capsule of the kidney may break, or, as they say, the kidney will come off, which leads to a relapse of the disease. Such consequences are rare because of non-compliance with bed rest and limited physical activity by the patient.
2. Due to inadequate hemostasis( stopping bleeding in the operating field), a hematoma can form which does not require any repeated interventions and resolves itself.
3. When applying seams, the surgeon can mistake the nerve stem n by mistake. Genio-femoralis.
4. Limitation of kidney mobility if it is incorrectly fixed( too low or high).

The prognosis regarding life and recovery of the patient is favorable. Provided a successful operation and accurate compliance with the right doctor's recommendations, complete and definitive recovery occurs in 3 years.

Reviews

Doctors today prefer laparoscopic nephropexy and consider it advisable to perform such an operation to fix the kidney, as this significantly improves the quality of life of patients. After nephropexy, recurrences of the disease are very rare, and if they occur, it is more often because of the patients themselves.