Laparoscopic Management Of Autosomal Dominant Polycystic Kidney

Objective : To investigate the methods and clinical value of Laparoscopic cyst decortication for the therapy of ADPKD.Methods: From October 2002 to February 2004,81 ADPKD patientswith chroic pain(N=37), hepertension(N=41), and renal insufficiency (N=37 ) underwent 94 LCD procedures .The mean age of the patients was 43 years old (range 28~59 years). All these cases treated with ransperitoneal laparoscopy were reviewed retrospectively in the fields of indications to operation, preoperative preparation, approaches, postoperative complications and how to accomplish operation.Result: 78 cases were treated successfully with the mean operating time was 2.2 hours (range 1.5~7.5 hours) and mean estimated blood loss was 185ml (range 65~1200ml).An anverage of 195 cysts(range 10~480) were treated per patient. The mean follow-up was 7.5 months(range 3-29months). The postoperation hospital stay were 4~15 days with an average of 5.6 days. The mean time to oral intake was1.8 days ( range 2~ 6 days) .Two patients were converted to open surgery. one underwent open renal cysts decortication ,the other subsequently underwent nephrectomy. One patient's ureter was injured in the LCD procedure and underwent ureter reanastomosis by the laparoscopic management subsequently. Most cases were satisfied with the clinical effect. The pain free rate was 85% ,79 % ,73 % and 69% at 3,5,12 and 24 months,respectively.The hypertension symptom relief rate was 70% ,65 % ,59% and 50% at 3,5,12 and 24 months,respectively.Conclusion: For ADPKD patients with debilitating pain, extensive LCD can provide durable relief. In the majority of patients with pain and hypertension, a marked improvement in blood pressure also occur. Cyst decortication was not associated with worsening renal function; indeed, renal function remained largely unchanged over the follow-up period. LCD offers the potential benefits of scant intraoperative blood loss, minimal postoperative pain, brief hospital stay, and rapid convalescence, while offering a short-term outcome equivalent to open surgery.