Laparoscopic nephrectomy in geriatric patients and comparison with standard nephrectomy

Introduction: We report our experience with laparoscopic nephrectomy in com parison to open nephrectomy in geriatric patients. The laparoscopic techniq ue is presented and the results an discussed with respect to the data from the current literature. Material and Methods: Since 1993, a total of 249 patient have undergone a n ephrectomy for benign renal disease. In 131 patients a laparoscopic nephrec tomy tin most cases via a transperitoneal approach) was performed and in 11 8 patients an open nephrecromy via a flank incision. Clinical parameters we re compared between both groups as well as with respect to different age gr oups. Results: There were no differences in terms of operative results (operative time, pre- and postoperative hemoglobin) between the laparoscopy group and open nephrectomy group as well as among the different age groups. Patients in the laparoscopy group demonstrated significant advantages with respect to blood loss, transfusion rate, analgesic consumption, hospital stay, and convalescence. These advantages were not related to patient age. The compli cation rate was comparable for both groups; however, both groups showed an elevation of the complication rate in the age groups 75 to 84 years. The mo rtality rate within the first 30 days after nephrectomy was 1.7% in the ope n nephrectomy group. Conclusions: The laparoscopic nephrectomy offers comparable operative resul ts (with less blood loss and a lower transfusion rate) when compared to ope n nephrectomy. In terms of postoperative parameters, patients in the laparo scopy group have significant advantages. Especially geriatric patients bene fit from these advantages and, therefore, the laparoscopic approach should be the preferred technique for a nephrectomy in these patients.