Indications and contraindications for nephrectomy, as well as kidney removal in a child

Nephrectomy is a surgical procedure involving the removal of the kidney. Such an operation is performed under general anesthesia and is of two types: open and laparoscopic nephrectomy. Removal of the kidney in a child is carried out only with serious anomalies of a congenital nature.

An open type of nephrectomy is performed for the patient in a lying position on a healthy side. In this case, the doctor makes a small incision in the zone of the waist of the oblique direction, dissecting layer by layer each. Going to the kidney, it is isolated from the fat capsule and removed to the surface of the formed wound. Then the ureter and renal vessels are bandaged and cut simultaneously with the renal pedicle.

As a result of such manipulations, the kidney is released from the fixing parts and is easily removed. The operating field is sewn up after draining, and the duration of the operation is about two to three hours.

Laparoscopy for kidney removal is organized without a large incision. On the front side of the abdominal wall, three to four holes of no more than 2 cm each are made to introduce special instruments. The operation is controlled by a camera located at the end of the tube inserted into the body cavity. The doctor also performs the removal of the renal peduncle. This operation is considered more complicated by the technique of execution compared to open intervention.

Carrying out and preparation for operation

Carrying out the operation involves the organization of removal of the kidney and surrounding tissues. With partial nephrectomy, only the affected or infected part is removed. Complete nephrectomy involves removing the kidney entirely, parts of the ureter, adipose tissue around the kidney, the adrenal gland

. Before starting the surgery, the patient must take blood tests to establish a blood group and cross-analyze if a blood transfusion is required during nephrectomy. A catheter is also installed in the bladder of the patient. The patient is told about the main stages of nephrectomy and possible complications.

Indications for operation

Removal of the kidney is performed in the following situations:

• Tumor of a kidney larger than 7 cm
• Urolithiasis, accompanied by the formation of large stones or complications of a purulent nature.
• Kidney injury, which does not lend itself to traditional treatment.
• Gunshot wound of the kidney, which provoked the destruction of the structure of the organ.
• Kidney failure.
• Non-functioning kidney.
• Deviations in kidney development, accompanied by frequent exacerbations.
• Kidney polycystic disease.

Contraindications to operation

It is forbidden to perform kidney removal in the following cases:

• The presence of only one kidney.
• Damage to the second kidney is a serious illness leading to its dysfunction.
• Blood clotting disorder.
• Taking medications that promote blood thinning. The operation is allowed no earlier than a week after stopping the reception.
• Decompensation of heart pathologies.
• Decompensation of diabetes mellitus.

Consequences of operation

The condition after kidney removal involves the administration of strong pain medication to the patient.

It is allowed to take food the very next day after the surgery, there are no special restrictions on the use of foods and dishes.

Two to three days after nephrectomy, it is recommended to organize mild motor activity - for example. Short walks along the corridor of the hospital.

The drains left from the operation are removed after five days, and the seams are removed after eight to twelve days. Then, for one month, you need to limit physical activity and wear a special bandage after removing the kidney. Subsequently, the patient gradually returns to normal life. After the laparoscopic intervention, a person is discharged from the hospital after five days.

Obligatory condition of normal vital activity with one kidney is strict observance of rules of preventive maintenance of infectious lesions of urinary system. To do this, it is necessary to prevent hypothermia, to visit a specialist on time, even with minimal suspicions of an inflammatory process in the body, especially for organs in the pelvic area and space behind the peritoneum.

With regard to survival after nephrectomy, it remains excellent in related donors, and mortality in this situation is approximately three to 10,000 donors. Most complications after surgery develop due to the risk of infection, bleeding, hypersensitivity reactions to anesthesia, thromboembolism.

In patients who underwent surgery due to the development of renal cell carcinoma, survival rates depend on the stage of tumor development and on the overall health of the patient. The survival rate for five years in patients with stage 1 renal cell carcinoma is 90-100%, in patients with the second stage - 65-75%, in the third and fourth steels, in the presence of distant metastasis, the survival rate decreases to five years40 - 70%.For these people, simultaneous organization of radiation therapy, chemotherapy and immunotherapy is required.

Patient care after operation

After surgery, patients experience severe discomfort in the incision zone. Also, patients who have undergone nephrectomy complain of a violation of sensitivity due to dissection of nerves in the area of ​​the location of the surgical wound.

During the postoperative period, patients are shown to take strong painkillers, as well as, if necessary, throughout the recovery time. To prevent the formation of pneumonia, the organization of breathing exercises is required, despite the fact that they are capable of causing pain due to the proximity of the placement of the surgical incision to the diaphragm.

Possible complications of surgical intervention can be as follows: infection with infection, postoperative pneumonia, heavy bleeding. Also, there is a risk of kidney failure in people with poor performance or damage to the remaining kidney.