Moderated Poster

Poster, Podium & Video Sessions

MP23-14: En-Bloc Stapling of the Renal Hilum during Laparoscopic Nephrectomy for Benign Inflammatory and Infectious Renal Pathology: A Multi-institutional Analysis of Safety and Efficacy

Saturday, May 13
7:00 AM - 9:00 AM
Location: BCEC: Room 151

Presentation Authors: Alyssa Greiman*, Charleston, SC, Alexander Chow, Melanie Adamsky, Christopher Coogan, Scott Eggener, Arieh Shalhav, Kalyan Latchamsetty, Chicago, IL, Sandip Prasad, Charleston, SC

Introduction: During laparoscopic nephrectomy (LN), the renal artery and vein are traditionally dissected and ligated separately due to concern for increased risk of arteriovenous fistula (AVF) formation with en-bloc stapling of the renal hilum (EBSH). As the majority of data supporting this claim arises following nephrectomy for infectious and inflammatory conditions, we sought to evaluate the safety and efficacy of EBSH during LN for benign infectious and inflammatory renal conditions.

Methods: We performed a retrospective review of patients with benign inflammatory and infectious renal pathology undergoing LN using EBSH between 2008 and 2014 at three academic medical centers. Data analyzed included pathology, operative time, estimated blood loss (EBL), and perioperative or postoperative complications. Evaluation of AVF formation was assessed by postoperative imaging studies, physical exam (absence of abdominal bruit or palpable thrill), or evaluation of new onset diastolic hypertension.

Results: 67 patients (mean age 55 +/- 16.2) underwent LN for a total of 71 renal units. EBSH was used in all cases (38 left renal units, 33 right renal units). Mean operative time was 174 min (range 84 to 373 min). Mean EBL was 150ml (range 20 ml to 2000 ml). One (1.8%) laparoscopic case was converted to open nephrectomy. The predominant pathology was obstruction in 23 (34.3%) and chronic infection in 23 patients (34.3%). Eleven (16.4%) patients had ESRD and 9 (13.4%) were on dialysis at the time of LN, with 4 (6.0%) patients going on to receive renal transplantation. No patients developed clinical or radiographic evidence of AVF at a mean follow-up of 14 months.

Conclusions: Ligation of the entire renal hilum with en-bloc stapling during LN is safe and effective. No patients in our cohort developed any significant immediate or intermediate term surgical complications or development of AVF as a result of en-bloc ligation. This study offers the largest cohort of en-bloc stapling in benign infectious and inflammatory kidneys to date, with no resulting radiographic or clinical diagnoses of AVF.

Source Of Funding: none

Alyssa Greiman, MD

Medical University of South Carolina

Alyssa Greiman is a PGY3 Urology Resident at the Medical University of South Carolina in Charleston, SC. She received her Bachelor of Science degree at Northwestern University in 2009 and then completed her medical school training at Feinberg School of Medicine, Northwestern University in 2014. She plans on pursuing a fellowship in Female Pelvic Medicine and Reconstructive Surgery after completing her residency training.

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MP23-14: En-Bloc Stapling of the Renal Hilum during Laparoscopic Nephrectomy for Benign Inflammatory and Infectious Renal Pathology: A Multi-institutional Analysis of Safety and Efficacy



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