Laparoscopic versus open nephrectomy for xanthogranulomatous pyelonephritis: An outcome analysis

Abstract

Context: Current literature suggests that laparoscopic nephrectomy (LN) in patients with xanthogranulomatous pyelonephritis (XGP) is associated with high conversion and complication rate.

Aims: To report contemporary outcome of patients with XGP, managed with either open nephrectomy (ON) or LN.

Settings and design: In this retrospective study, medical records of 37 patients with histopathologically confirmed XGP from January 2001 to October 2009 were reviewed.

Materials and methods: The clinical presentation, preoperative course, intraoperative findings, postoperative recovery and complications in ON and LN were analyzed.

Statistical analysis: Student's t test was used to perform statistical comparison between the LN and ON groups. Values are expressed as mean ± standard deviation.

Results: In 37 patients, 20 underwent ON and 17 underwent LN. One patient in the LN group required conversion. He had ectopic pelvic kidney, and the vascular pedicle could not be identified because of dense adhesions. There were no intraoperative complications. The mean blood loss was 257.5 ± 156.67 ml and 141.18 ± 92.26 ml in ON and LN groups, respectively. Mean hospital stay was 15.45 ± 7.35 days and 9.71 ± 4.55 days in ON and LN groups, respectively. Postoperative complications were classified according to Clavien grading for surgical complications. Grade 2 complications were seen in 40% and 29.4% of patients in ON and LN groups, respectively. One patient in LN required secondary suturing of specimen retrieval site.

Conclusions: LN in patients with XGP is often challenging and requires considerable experience in laparoscopy. In properly selected patients, all benefits of minimally invasive surgery can be availed with LN.

Keywords: Laparoscopy nephrectomy; open nephrectomy; xanthogranulomatous pyelonephritis.

Figure 1

Preop CECT scan from a patient with XGP who underwent successful LN

Figure 2

Port placement

Figure 3

Specimen of a patient with XGP who underwent LN