Objective: To evaluate the outcomes of bilateral pretransplant nephrectomy (BPN) for small kidneys, using a bilateral dorsal lumbotomy (BDL) or transperitoneal laparoscopy (TL) approach.
Patients and methods: Fifty-eight patients with end-stage renal disease and small kidneys underwent BPN for various indications, most commonly uncontrolled hypertension. There were 38 patients in the BDL group (group 1) and 20 in the TL group (group 2). The variables before and during surgery, and the outcomes afterward, were compared between the groups.
Results: The mean age of the patients and male/female ratio were comparable in both groups. The mean size of the kidneys removed were 7.4 and 8.2 cm, respectively, in groups 1 and 2. The mean (range) operative duration was longer in group 2, at 210 (160-240) min, than in group 1, at 112 (90-150) min (P < 0.001). The postoperative analgesic requirement for pain, blood transfusion rate, wound and pulmonary complications were similar between the groups. Bowel function recovered earlier in group 1 than group 2 (19 vs 37 h, P < 0.001). The total cost for the nephrectomy in group 2 was 3.5 times that of group 1. The mean interval between nephrectomy and transplantation was similar in both groups.
Conclusion: BDL appears to be better than TL for BPN in small kidneys because the surgery is quicker, and there is earlier bowel recovery and lower costs.