Poster, Podium & Video Sessions
Presentation Authors: Justin Benabdallah*, Joel Vetter, Ramakrishna Venkatesh, R. Sherburne Figenshau, St. Louis, MO
Introduction: Xanthrogranulomatous pyelonephritis (XGP) has historically been managed with open nephrectomy. In the era of minimally invasive surgery, a small number of reports have evaluated the use of a laparoscopic approach in XGP, with variable results. We evaluated our experience with XGP over the last 15 years. This represents the largest series to date of laparoscopic nephrectomy for XGP.
Methods: Retrospective review of all nephrectomy and partial nephrectomy specimens from May 2001 to August 2016 disclosed 31 patients with pathologically confirmed XGP. 28 patients underwent total nephrectomy (18 laparoscopic, 1 robotic, 9 open) and 3 patients underwent partial nephrectomy (2 robotic, 1 open). Conversion to open was performed in 3 of the laparoscopic cases. The probability of undergoing laparoscopic nephrectomy significantly increased over time (p=0.063).
Results: There were no differences in overall complication rate (38.9% vs. 53.8%, p=0.48), Clavien I and II complications (22.2% vs. 30.8%, p=0.689), Clavien III and IV complications (16.7% vs. 23.1%, p=0.67), readmissions (22.2% vs. 23.1%, p=1.0), or mean operative time (191 vs 209, p=0.31). Blood loss (350 vs. 775, p= 0.009) and intraoperative transfusion rate (11.1% vs. 53.8%, p =0.017) were significantly higher in the open group. There were no perioperative mortalities in either group. The mean hospital length of stay was 8 days for the open group and 3.2 in the laparoscopic group (p<0.001). Median follow-up was 47 days. Patients with preoperative glomerular filtration rate of <60, blood loss >1 liter, or hospital stay >9 days were more likely to suffer a major complication or require readmission.
Conclusions: Although early reported experience with laparoscopic nephrectomy for XGP was not favorable, our larger and more contemporary series demonstrates it can be performed safely, with less blood loss and shorter hospital stays. Complication rates and readmission rates are high regardless of approach.
Source Of Funding: None
Washington University in St. Louis
Dr. Justin Benabdallah is currently completing his Endourology fellowship at Washington University in St. Louis with a focus on laparoscopic and robotic surgery. His residency was completed in Milwaukee, WI at the Medical College of Wisconsin. He spent his educational years in Virginia, matriculating at The College of William and Mary (BS, Biology 2006) and The Medical College of Virginia/ VCU (MD 2011).
Saturday, May 13
7:00 AM – 9:00 AM