Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis in childhood: The way forward

Abstract 

Objective

Xanthogranulomatous pyelonephritis (XGP) is a severe, chronic renal parenchymal infection. Nephrectomy is curative. Open nephrectomy is a well-known operative challenge. We describe successful laparoscopic nephrectomy in three patients with XGP.

Materials and methods

Case notes and radiology of three patients who underwent laparoscopic nephrectomy for XGP were reviewed. The preoperative presentation, operative details, postoperative recovery and complications were recorded.

Results

The ages of the three children were 9, 5 and 1.3years. Retroperitoneoscopy was performed via 3×5-mm ports. Creation of retroperitoneal space was easier than anticipated despite the perinephric inflammation. Excellent visualization of renal pedicle was obtained. The renal vessels were divided using the ultrasonic dissector (Sonosurg, Olympus). The kidney was then mobilized and dissected off adjacent structures. It was extracted via a small extension to one of the incisions on each occasion. None of them needed conversion. Average operating time was 3h and 30min. Histology of XGP was confirmed in all.

Conclusions

Laparoscopic nephrectomy has replaced open nephrectomy for most conditions. Preoperatively, it was thought that laparoscopy might be unsuitable because of the involvement of perinephric tissues commonly seen in this condition; however, excellent visualization was achieved enhancing the ease of dissection. Dealing with the pedicle before handling the kidney also proved beneficial, allowing better visualization and safe dissection. Postoperative pain and morbidity were greatly reduced. The cosmetic result was excellent. We recommend the laparoscopic approach for nephrectomy in XGP when expertise is available.

Keywords: Xanthogranulomatous pyelonephritis (XGP), Laparoscopy, Nephrectomy, Paediatric