Removal through the pelvis
Through the lumbar incision, the kidney is isolated, the posterior surface of the pelvis is exposed - there are no large vessels here; the pelvis is opened, and the stone with spurs is carefully removed entirely, if necessary, with the expansion of the necks of the cups (extended pyelolithotomy according to Gil-Vernet). The cavities are washed, controlled by X-ray or nephroscope for the absence of fragments, and the pelvis is sutured on a nephrostomy. The method is chosen for the extrarenal type of pelvis; with a narrow intrarenal pelvis and long spurs, nephrolithotomy is required.
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.
