Laparoscopic Nephropexy: Washington University Experience

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Abstract
We evaluated the efficacy of laparoscopic nephropexy for symptomatic nephroptosis. We performed laparoscopic right nephropexy in 6 patients who presented with symptomatic nephroptosis documented by radiographic studies and/or renal scans. In the first patient Gerota's fascia was secured to the peritoneal reflection of the line of Toldt using tacking clips. In the subsequent 5 patients the lateral border of the kidney was sutured to the overlying fascia of the quadratus lumborum muscle using an intracorporeal suturing technique. Additionally, the superior edge of the incised infrahepatic triangular ligament was sutured to the anterior mid portion of the renal capsule, thereby creating a vertical and horizontal means of fixation. Laparoscopic right nephropexy was successful in all 6 patients. Average operative time was 4 hours. All patients resumed oral intake during postoperative day 1. Average parenteral analgesia requirement postoperatively was 42.7 mg. morphine. Hospital stay averaged 2.5 days and patients returned to usual activities an average of 2.5 weeks postoperatively. Postoperative imaging studies confirmed a decrease in or resolution of nephroptosis in all patients. All patients remained asymptomatic for an average of 11 months (range 2 to 30). Laparoscopic nephropexy appears to be a feasible treatment option for patients with symptomatic, documented nephroptosis. The procedure can be accomplished safely and effectively with satisfactory anatomical and clinical results.