Anatrophic nephrolithotomy
After isolating the kidney and temporarily clamping the renal artery (with cooling of the kidney to protect against ischemia), the surgeon dissects the parenchyma along the anatrophic line, where the boundaries of the segments of the blood supply coincide and bleeding is minimal. Opened cups allow all spurs to be removed; the narrow necks of the cups are cut and plastered. The parenchyma is sutured, blood flow is restored; A nephrostomy tube and a stent are installed. Renal function is preserved in most patients with an ischemia time of up to 30 minutes. After surgery - long-term antibacterial prophylaxis and MSCT monitoring.
Place of open operations today
Percutaneous nephrolithotripsy removes most staghorn stones through a puncture, so open surgery is performed in 1–3% of cases: with giant staghorn stones filling all the calyces, when PCNL would require 3–4 approaches and several stages; in case of kidney anomalies, the inability to create percutaneous access, the need for simultaneous reconstruction of the pelvis or severe obesity. The advantage of open surgery is that the entire stone is removed at one time.
Recovery
In the hospital - 7-10 days: the nephrostomy is removed 5-7 days after the control pyelography, drainage - after 3-4 days. Limitation of loads - 6-8 weeks. Coral stones are usually infectious, so long-term antibacterial prophylaxis and monitoring of urine tests are carried out after surgery. Control MSCT after 1–2 months; residual small fragments are crushed by ESWL.
