Features of nephrectomy hemodialysis dependent patients. Experience of the regional center

Abstract

Background. A feature of the postoperative period of patients with end-stage chronic kidney disease (ESKD) after nephrectomy is the need to continue hemodialysis sessions, taking into account the high risk of developing hemorrhagic complications. A significant place in the literature devoted to organ removal surgery is devoted to a discussion of the video endoscopic method, which, as medicine develops, is constantly being improved, modified and noted as one of the promising areas. Open surgical interventions are accompanied by a more severe course. In this connection, the issue of choosing the timing and method of surgical intervention for this group of patients remains relevant. Aim. To evaluate the results of nephrectomy of hemodialysis patients for the period from 2013 to 2023, performed at the Krasnoyarsk Regional Clinical Hospital. Materials and methods. An analysis of 68 cases of nephrectomy was carried out to evaluate the effectiveness of the protocol adopted in the clinic for the management of nephrectomy in hemodialysis patients. The group included 31 (44.6%) men and 37 (55.4%) women. Nephrectomy through the lumbotomy approach was performed in 31 (45.6%) patients, laparoscopic unilateral nephrectomy – in 23 (33.8%) patients, and bilateral laparoscopic nephrectomy – in 14 (20.6%) patients. Results. Patients with ESKD who underwent nephrectomy were divided into 3 groups – emergency, elective open and laparoscopic nephrectomy. The end-stage of chronic kidney disease and the need for hemodialysis sessions are aggravating factors in the peri- and postoperative treatment of patients with a higher risk of developing complications, in order to minimize which the clinic has adopted a specialized protocol for the management of this category of patients, consisting of preoperative preparation, intraoperative and postoperative stages, applied in 89.7% of cases. Open surgical interventions were performed in 31 patients. Laparoscopic bilateral nephrectomy was performed in 14 patients and was carried out exclusively as planned. Laparoscopic monolateral nephrectomy was performed in 23 patients. Indications for surgical intervention in most patients were the presence of a complicated infection against the background of impaired urodynamics of the upper urinary tract, planned kidney transplantation in patients with polycystic disease, diagnosed malignant tumors of the kidney and ureters. The analysis indicates a greater number of hemorrhagic complications during open interventions. The introduction of endovideosurgical nephrectomy and patient management according to a specialized protocol leads to a significant reduction in the incidence of postoperative complications. Conclusion. Surgical minimally invasiveness and the use of a specialized protocol for the management of hemodialysis-dependent patients makes it possible to reasonably expand the indications for planned interventions, reducing the peri- and postoperative risks of a complicated course.