Ces Urol 2010, 14(1):32-38 | DOI: 10.48095/cccu2010005

Laparoscopic nephropexis - technique with three non-absorbable stitches

Milan Hora, Viktor Eret, Petr Stránský, Tomáš Ürge, Jiří Klečka jr.

Urologická klinika LF UK a FN Plzeň

Aim:
When we resolved on starting laparoscopic nephropexy we decided for the simplest method - laparoscopic transperitoneal with three non-absorbable stitches. We present our opinion with this operation.

Material and methods:
From 12/2004 till 5/2008, nephropexy was performed in 13 women. Twelve times on the right side, once on both sides. The technique of operation: We used 10 mm port for camera through umbilicus and further two working ports (5 and 10 mm). The peritoneum is opened in Toldts line. The lateral part of the kidney and the adjacent abdominal wall are cleaned. The kidney is fixed to the abdominal transversal muscle with three or four separate stitches (intracorporal tying) from non-absorbable material - polypropylene, 2/0, needle 31 mm. The peritoneum defect is closed with a running polyglactine suture anchored with absorbable PDS clips. No drain is placed. The patient lies for three days. We recommend avoiding jumping, horse-riding etc for two months.

Results:
Mean age was 34.1 ? 11.8 (20.0 to 61.3) years. Mean BMI 21.9 ? 2.8 (17.3-26.7). Mean time of operation in one side procedure 73.1 ? 13.9 (55-100) , bilateral procedure took 155 minutes. Mean follow-up is 26.4 ? 12.7 (2-55) months. All procedures were without blood loss and peroperative and postoperative complications. Long term results: Two were lost for follow-up. Eight are stable, one suffers from recurrent urinary tract infections, and two suffer from pain; one from flank pain in gravidity and after childbirth and one from neuralgic pain in the region of the right hip joint. Four underwent control urography in one case a residual nephroptosis 4 cm was found, but she is stable.

Conclusion:
Laparoscopic transperitoneal nephropexy with three non-absorbable stitches is easy, fast and relatively efficient. Neuralgia in one case can be due to postoperative irritation of the nerve caused by the stitch. We recommend careful liberation of the abdominal wall enabling safe suturing without damage to nerves.

Keywords: nephropexy, laparoscopy

Received: June 2, 2009; Accepted: July 3, 2009; Published: January 1, 2010