Xanthogranulomatous pyelonephritis: No longer a contraindication for laparoscopic surgery?

Summary 

Background

Xanthogranulomatous pyelonephritis is a chronic renal inflammatory condition associated with significant renal and peri-renal inflammation. Consequently, operative treatment of this condition has traditionally been by open nephrectomy rather than the laparoscopic approach. We report our experience with the diagnosis and management of XGP in our department, which has subsequently been histologically confirmed.

Patients and methods

We reviewed records of all patients with a histological diagnosis of XGP between 1984 and 2007. 20 patients with a diagnosis were included. Patient demographics, preoperative presentation, diagnostic imaging, operative details, post-operative recovery and complications were included in our data.

Results

13 patients underwent open nephrectomy and 7 patients underwent a laparoscopic procedure, of which 1 was subsequently converted to an open procedure. Blood loss, analgesic requirement, time to first meal and length of stay (LOS) in hospital were all lower in the laparoscopic group compared with the open group (362.5ml vs. 723.6ml, p=0.049; 65.3mg vs. 146.9mg, p=0.153; 2.8 days vs. 4.2 days, p=0.184; 4.4 days vs. 9.8 days, p=0.084). Operative times were similar in both groups (157.5min vs. 154.2min, p=0.888). There were 5 complications in the laparoscopic group and 13 in the open group.

Conclusion

The laparoscopic approach, although technically challenging, provides superior intra-operative and post-operative recovery results compared to the open approach with comparable operative times and incidences of complications. In specialised centres and in experienced hands, laparoscopic nephrectomy should be considered as the first choice procedure in those patients with a suspected diagnosis of XGP.

Keywords: Xanthogranulomatous, Pyelonephritis, Laparoscopic, Nephrectomy, Renal, Inflammation