Affiliation:
1. Associate professor, Surgery Department of Surgery, Muzaffarnagar Medical College , Muzaffarnagar.
Abstract
Purpose- PCNL is difficult in obese, and has increased risk of peri-operative complications in obese ,it was decided to retrospectively analyse from our patients, of last 8 yrs, to determine stone free status and complication rates.
Material and Methods- Study was between January 2011- January 2019 , 78 morbidly obese patients were randomised, with body mass index over 35 who had indication of PCNL , stones larger than 2 cms and stones smaller in size and treatment unfit for ESWL (extra corporeal shock wave lithotripsy) if stone skin difference was high, or ESWL resistant hard stones were enrolled. Patients randomly assigned in two groups, Group 1 standard PCNL with Nephrostomy and a Stent ,Group 2 Totally tubeless with no Nephrostomy and no Stent, and the outcomes were compared.
Results- The transfusion rate, operative time and the drop in hemoglobin were same in both groups (p>0.05). Total analgesic use was equivalent of 33.8 vs 14.7 mgs of morphine sulfate (18-77mg) and was significantly lower in tubeless group(p=0.001). Return to normal was described as total number of in-patients and outpatients days from time of admission to the point which the patient returns to normal activity such as going to job and was 19.4 vs 9.3 days (6-30 days, p=0.001)
Conclusion- Totally tubeless PCNL in obese patients had lower analgesic use and return to normal activity vs standard PCNL. Totally tube less PCNL is recommended for obese patients.