Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings.

Academic Article

Abstract

  • OBJECTIVES: • To determine the frequency of delayed postoperative haemorrhage requiring selective angioembolization (SAE) after laparoscopic partial nephrectomy (LPN). • To describe the clinical presentation and characterize the angiographic findings encountered in this setting. PATIENTS AND METHODS: • Prospective data from 640 LPNs performed between August 1993 and May 2009 were retrospectively analyzed, from which patients with delayed postoperative haemorrhage (defined as 'gross haematuria ≥ 7 days postoperatively that persists for more than 24 h') and requiring SAE were identified. • Clinicopathological, preoperative and perioperative factors were reviewed. • Selective catheterization and angiography of the renal artery was performed for persistent gross haematuria and for haemodynamic instability associated with a significant drop in haematocrit level. • Arteries feeding the bleeding site were identified and embolized with endovascular coils. RESULTS: • Patients presented with delayed haemorrhage between 7 and 30 days after surgery. SAE was required in 13 patients (2%) for delayed postoperative bleeding. • Of the 640 LPNs, 68 (10.6%) were performed without hilar occlusion ('off-clamp') of whom one (1.5%) had a delayed haemorrhage, which was successfully embolized. • For patients with and without delayed haemorrhage after LPN, the mean tumour size was 2.7 cm and 3.3 cm (P= 0.31), the mean warm ischaemia time was 28.2 min and 14.3 min (P < 0.001), and the mean estimated blood loss 403.8 mL and 308.2 mL (P= 0.26), respectively. • Percutaneous angiography showed renal artery pseudoaneurysm in 10 patients and arterial contrast extravasation in three patients, two of whom also had an arteriovenous fistula. • Following embolization, creatinine levels remained stable in all patients. CONCLUSIONS: • Clinically significant delayed postoperative bleeding after LPN occurs in a small percentage of patients. • Angiography will accurately make the diagnosis of RAP or AVF and SAE is safe and effective procedure that allows for preservation of renal function.
  • Published In

  • BJU International  Journal
  • Keywords

  • Adult, Aged, Aged, 80 and over, Aneurysm, False, Arterio-Arterial Fistula, Embolization, Therapeutic, Epidemiologic Methods, Female, Humans, Kidney Neoplasms, Laparoscopy, Male, Middle Aged, Nephrectomy, Postoperative Hemorrhage, Radiography, Renal Artery, Treatment Outcome, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • Montag S; Rais-Bahrami S; Seideman CA; Rastinehad AR; Vira MA; Kavoussi LR; Richstone L
  • Start Page

  • 1460
  • End Page

  • 1466
  • Volume

  • 107
  • Issue

  • 9