BILATERAL OPEN TRANSPERITONEAL CYST REDUCTION SURGERY FOR AUTOSOMAL-DOMINANT POLYCYSTIC KIDNEY-DISEASE

Purpose: We reviewed our experience with open transperitoneal bilatera l renal cyst reduction surgery in patients with symptomatic autosomal dominant polycystic kidney disease to define perioperative morbidity a nd mortality, and to suggest that others consider this mode of therapy when more conservative methods fail to provide relief from pain or ea rly satiety. Materials and Methods: A total of 28 patients underwent 3 0 transperitoneal bilateral renal cyst reduction decompression operati ons between May 1987 and June 1996. Ten procedures included surgical t reatment of concomitant liver cysts (8 by liver cyst marsupialization and 2 by partial hepatic resection). Records were reviewed for hospita l stay, perioperative morbidity, changes in renal function and hyperte nsion control. Results: Hospitalization averaged 9 days. Treatment of hepatic cysts, age and renal insufficiency did not extend hospitalizat ion. A transient reduction in renal function occurred after 20 procedu res. The most frequently encountered perioperative morbid events were ileus in 4 patients and cardiac arrhythmias in 3. The most significant complications were myocardial infarction in 1 patient and fatal adult respiratory distress syndrome after partial liver resection in anothe r. Preoperative renal insufficiency, age and treatment of hepatic cyst s were not associated with increased morbidity. Six patients had impro vement in hypertension and none had sepsis. Conclusions: Bilateral tra nsperitoneal renal cyst reduction surgery is a relatively safe and eff ective treatment for individuals with symptomatic polycystic kidney di sease in whom more conservative therapies have failed.