OUTPATIENT NEPHRECTOMY FOR NONFUNCTIONING KIDNEYS

We describe a surgical approach that allows multicystic dysplastic and nonfunctioning hydronephrotic kidneys to be removed on an outpatient basis through a 2.5 to 3 cm, subcostal incision. In the last 5 years 4 0 children (age 4 months to 5 years, mean 8.2 months) were scheduled f or outpatient nephrectomy in an ambulatory surgical unit in a hospital setting. Of the 40 patients 30 had a multicystic kidney. Renal size r anged from 3 x 2 to 9.5 x 7.2 cm. Operative time ranged from 20 to 70 minutes (mean 45.4). In 34 cases (85%) an intercostal block was also p erformed to provide analgesia for 18 to 24 hours. Nephrectomy was done on an outpatient basis in 39 of the 40 children (98%). Mean pain scor e (range 0 to 5) in the last 19 patients who underwent an intercostal block was 0.68 at discharge from the hospital, 0.85 at bedtime and 0.9 5, 24 hours later. We conclude that nephrectomy may be performed throu gh a small incision on an outpatient basis with minimal morbidity, and that this approach offers an alternative to laparoscopic nephrectomy and nonsurgical management of these kidneys.