LAPAROSCOPIC NEPHROPEXY - WASHINGTON-UNIVERSITY EXPERIENCE

Purpose: We evaluated the efficacy of laparoscopic nephropexy for symp tomatic nephroptosis. Materials and Methods: We performed laparoscopic right nephropexy in 6 patients who presented with symptomatic nephrop tosis documented by radiographic studies and/or renal scans. In the fi rst patient Gerota's fascia was secured to the peritoneal reflection o f the line of Toldt using tacking clips. In the subsequent 5 patients the lateral border of the kidney was sutured to the overlying fascia o f the quadratus lumborum muscle using an intracorporeal suturing techn ique, Additionally, the superior edge of the incised infrahepatic tria ngular ligament was sutured to the anterior mid portion of the renal c apsule, thereby creating a vertical and horizontal means of fixation. Results: Laparoscopic right nephropexy was successful in all 6 patient s. Average operative time was 4 hours. All patients resumed oral intak e during postoperative day 1. Average parenteral analgesia requirement postoperatively was 42.7 mg. morphine. Hospital stay averaged 2.5 day s and patients returned to usual activities an average of 2.5 weeks po stoperatively. Postoperative imaging studies confirmed a decrease in o r resolution of nephroptosis in all patients. All patients remained as ymptomatic for an average of 11 months (range 2 to 30). Conclusions: L aparoscopic nephropexy appears to be a feasible treatment option for p atients with symptomatic, documented nephroptosis. The procedure can b e accomplished safely and effectively with satisfactory anatomical and clinical results.