Laparoscopic transperitoneal heminephrectomy for duplex kidney in infants and children: a comparative study.

Dingemann, Carmen; Petersen, Claus; Kuebler, Joachim F; Ure, Benno M; Lacher, Martin

BACKGROUND AND OBJECTIVE Evaluation of the feasibility, safety, and outcome of laparoscopic heminephrectomy for duplex kidneys in children above and below the age of 12 months. PATIENTS AND METHODS The transperitoneal surgical technique included division of the parenchyma with a sealing device (LigaSureâ„¢; Covidien, Mansfield, MA) and amputation of the ureter as low as possible. A follow-up study was performed. Patients' records were analyzed retrospectively for operative details and postoperative complications. Long-term outcome was assessed during follow-up visits and a final telephone interview. Outcome was compared between two groups: Group 1 (G1), age at surgery<12 months; Group 2 (G2), age at surgery >12 months. RESULTS Between July 2004 and September 2012, in total, 22 laparoscopic heminephrectomies (20 upper poles and 2 lower poles) were performed in 20 patients (G1, 12 cases; G2, 10 cases). A mean (range) age at surgery was 7.1 (3-11) months in G1 and 49.4 (15-128) months in G2. Mean (range) operative time was 152 (81-220) min in G1 and 197 (90-265) min in G2 (P=.06). All procedures were completed laparoscopically. Major postoperative complication was one urinoma in G1, which was surgically revised. Mean hospital stay was 3.6 days (G1, 4.0 days; G2, 3.1 days). During long-term follow-up (median, 5.2 years) febrile urinary tract infections occurred to the same extent in both groups (G1, 1/12; G2, 2/10; P=.57). CONCLUSIONS Laparoscopic transperitoneal heminephrectomy for duplex kidneys is safe and feasible even in small infants. Long-term results are excellent irrespective of the patient's age.