Features of secondary open surgery
Dense scars after previous interventions fuse the kidney with the peritoneum, intestines, diaphragm and large vessels, and in case of pyonephrosis - with the surrounding tissues in a single infiltrate. Sometimes it is safer to perform a subcapsular nephrectomy - remove the kidney from inside its capsule, leaving the capsule on the fused organs. Blood loss can be significant, so blood is prepared in advance. After surgery - drainage, antibiotics, 6-8 days in the hospital. A prerequisite is satisfactory function of the second kidney according to scintigraphy.
Indications for nephrectomy
- non-functioning kidney (function less than 10–15% according to scintigraphy) with terminal hydronephrosis, wrinkling, polycystic disease with complications;
- pyonephrosis - purulent melting of the kidney that cannot be drained;
- renal (nephrogenic) hypertension caused by a shriveled kidney;
- severe kidney injury with uncontrolled bleeding;
- non-functioning half of a double kidney (heminephroureterectomy) or a segment of a horseshoe kidney (heminephrectomy);
- recurrent infections and pain in a non-functioning kidney;
- donor nephrectomy for transplantation;
- secondary nephrectomy - after previously performed kidney surgeries (technically more difficult).
Laparoscopic and open nephrectomy
Laparoscopic nephrectomy is performed through 3-4 punctures of 5-12 mm in the abdominal wall or lumbar region under general anesthesia. The surgeon, on the monitor, isolates the kidney, separately clips and crosses the renal artery, vein and ureter, places the kidney in a special container and removes it through one of the punctures, slightly dilated if necessary. Blood loss is minimal, pain after surgery is much less, discharge is on the 3-4th day, and back to work after 2-3 weeks.
Open nephrectomy through an incision in the lumbar region is used in cases of severe inflammation and adhesions after previous operations (secondary nephrectomy), gigantic kidney size, severe trauma, or the impossibility of laparoscopy. Hospital stay 5–7 days, recovery 4–6 weeks. Heminephrectomy for a double or horseshoe kidney removes only the affected segment, preserving healthy tissue, and is often performed laparoscopically.
Preparation
The main question before removing a kidney is the condition of the second kidney: MSCT with contrast evaluates the anatomy of the vessels and both kidneys, and dynamic nephroscintigraphy evaluates the contribution of each kidney to the overall function. Removal is justified when the diseased kidney functions at less than 10–15%, and the healthy one can cope with the load. Tests: general and biochemical blood test with creatinine and GFR, coagulogram, urine analysis and culture with treatment of infection, ECG, consultation with an anesthesiologist and therapist. Anticoagulants are discontinued 5–7 days before. Hospitalization the day before, 8 hours on an empty stomach.
Recovery and life with one kidney
After laparoscopic surgery, the patient is raised the next day, the drainage is removed after 1–2 days, and discharged on the 3–4th day. Loads are limited to 4–6 weeks. A healthy kidney increases its work within a few months and fully compensates for the function - most people with one kidney live without restrictions. It is important to take care of it: control blood pressure and weight, drink enough water, avoid nephrotoxic drugs (non-prescribed NSAIDs, some antibiotics), check creatinine and ultrasound once a year.
Nephrectomy in Tashkent
In the clinics below, kidney removal is performed laparoscopically and openly, including secondary operations after previous interventions, heminephrectomy for anomalies, with MSCT diagnostics and intensive care observation in the hospital. Prices according to the clinic’s price list; Anesthesia and bed days are paid separately. Sign up for a consultation with MSCT results.
