10 This historical recommendation has been refuted by several recent reports, including the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2008 report that find more recommended that laparoscopic intervention can be performed in any trimester without any increased risk to the mother or fetus, if warranted by the patient’s condition.6 The issue of transperitoneal and retroperitoneal approach to laparoscopic nephrectomy in pregnancy is still open for discussion. The transperitoneal

route provides a larger working space, which is more desirable for pregnant Inhibitors,research,lifescience,medical patients.5 The retroperitoneal approach, on the other hand, provides early control of renal vessels and allows extraperitoneal dissection without bowel manipulation and, in pregnant patients, minimizes the uterine irritation and thus the risk of preterm labor.5,16 As a result of our limited experience with Inhibitors,research,lifescience,medical the retroperitoneal approach, we preferred the transperitoneal route. Our operative time of 188 minutes was within the range of reported cases. Among the

Inhibitors,research,lifescience,medical reported cases of laparoscopic nephrectomy in pregnancy, all had an uneventful outcome. Most (7/8) deliveries happened at term with healthy babies. Current literature provides important recommendations for safe laparoscopy during pregnancy. CO2 insufflation pressure should be kept between 10 to 15 mm Hg and intraoperative CO2 monitoring by capnography Inhibitors,research,lifescience,medical should

be used during laparoscopy in the pregnant patient.6,16 Intraoperative and postoperative prophylaxis for deep venous thrombosis and early postoperative ambulation are recommended in pregnant patients. Fetal heart monitoring should be done pre- and post-operatively.6 According to the latest SAGES guidelines, tocolytics should not be used prophylactically, but should be considered perioperatively in coordination with obstetric consultation when signs of preterm labor are Inhibitors,research,lifescience,medical present.6 Apart from laparoscopic appendicectomy and cholecystectomy, few successful laparoscopic adrenalectomies have been performed in gravid patients.11 In Fossariinae addition, some studies have shown equivalence between laparotomy and laparoscopy in pregnancy.12,13,19 However, a prospective study on the safety and effectiveness of laparoscopy during pregnancy, or for that matter, laparoscopic nephrectomy for pyonephrosis and nonfunctioning kidney is neither available at present nor likely to be performed in the near future. Conclusions Pyonephrosis in pregnancy needs urgent but safe intervention. The successful outcome of our case supports the view that transperitoneal laparoscopic nephrectomy is feasible and safe if standard precautions are exercised.

No related posts.