Page 8 - World Association of Laparoscopic Surgeons - Journal

WJOLS
10.5005/jp-journals-10007-1140
Laparoscopic Decortication of Simple Renal Cyst with Omental Wadding Technique: Single Center Experience
ORIGINAL RESEARCH
Laparoscopic Decortication of Simple Renal Cyst with

Omental Wadding Technique: Single Center Experience

M El-Shazly, A Allam, B Hathout

ABSTRACT A simple benign cyst (Bosniak I) has a thin wall without
septations, calcification or solid components. Its density
Objectives: The aim is to study the outcome of laparoscopic
decortication of symptomatic simple renal cyst with omental measures like water and does not show enhancement with
wadding technique in a single center. contrast material. 5
Methods: This is a retrospective study of 16 consecutive Most of simple renal cysts require no treatment,
patients who underwent transperitoneal laparoscopic intervention is indicated only when patients present with
decortication of symptomatic simple renal cyst with omental
symptoms or complications, such as UTI or upper urinary
wadding technique between November 2007 and November
tract obstruction. Sclerotherapy is the ideal primary
2011. The indication for surgery was for relief of pain in all cases.
Pain was assessed preoperatively and 1 and 6 months management especially for relatively small simple renal
postopertively using numerical rating pain scale. All cysts were cysts (less than 10 cm in its greatest dimension). It is a
more than 10 cm in its greatest dimension. Laparoscopic minimally invasive and safe procedure and it is frequently
decortication was the primary treatment in 13 cases and the
performed to treat these patients. However, the recurrence
secondary treatment in three cases after sclerotherapy. We used
rate after simple aspiration alone is 41 to 78%. Recurrence
the omental wadding technique to decrease the incidence of
recurrence. We reviewed the preoperative and postoperative rate is around 43% after single session of sclerotherapy and
data. is lowered to 5% after repeated sessions of sclerotherapy. 6-9
Results: The operation was successfully completed Since, the introduction of laparoscopy to urologic
laparoscopically in all cases with a mean operative time of 95 surgery in the 1990s, laparoscopic decortication of simple
minutes without major perioperative complications. Hospital stay
renal cysts has been reported to be an excellent modality of
was 2.4 days (range, 2 to 4 days). Fifteen cases improved
significantly after operation in a mean follow-up of 1.5 year. One management as it is effective and it can duplicate techniques
case only had radiological recurrence after 6 months of open surgery. This is together with the generic advantages
postoperatively. of laparoscopy; less invasive, less morbidity, less pain and
Conclusion: Laparoscopic decortication of large simple renal less analgesic use, short convalescence and rapid return to
cysts is an efficacious, safe and less invasive method of work. 10
treatment. Omental wadding is helpful to decrease the incidence
of cyst recurrence. Laparoscopic decortication is recommended PATIENTS AND METHODS
as a primary treatment for huge cysts or as a secondary
treatment after treatment failure with sclerotherapy. Sixteen patients with simple renal cysts were admitted to

Keywords: Renal cyst, Decortication, Laparoscopic, Omental Urology Department, Farwaniya Hospital, between
wadding. November 2007 and November 2011 and mean age 52 years,
range 27 to 68; seven males and nine females.
How to cite this article: El-Shazly M, Allam A, Hathout B.
Laparoscopic Decortication of Simple Renal Cyst with Omental All cases were presented with pain. Pain was assessed
Wadding Technique: Single Center Experience. World J Lap using numerical rating pain scale preoperatively and
Surg 2012;5(1):1-3.
postoperatively after 1 month and 6 monthly. Abdominal
Source of support: Nil ultrasonography and computed tomography with contrast
were performed for all cases preoperatively to assess type
Conflict of interest: None declared
of cyst and to rule out any connection to pelvicalyceal
INTRODUCTION system. All cases were diagnosed with symptomatic simple
renal cyst (Bosniak 1 and 2). The estimated mean largest
It is estimated that the incidence of renal cysts is 20% at 40 cyst dimension measured by CT was 14.5 cm (range from
1
years of age and 33% at 60 years population. Most of renal 11-19 cm). Fourteen cases had single cortical cyst, and
cysts are asymptomatic, the diagnosis is usually incidental two had more than one cyst. There were no parapelvic cysts
during abdominal ultrasonography. Up to 5 to 10% of renal in our series.
cysts are symptomatic. The main presentation is flank pain, Ultrasonography was repeated 1 and 6 months
occasionally patients may present with hematuria, postoperatively. CT was repeated postoperatively if
hypertension or UTI. 2-4 ultrasonography suggested the possibility of recurrence.

World Journal of Laparoscopic Surgery, January-April 2012;5(1):1-3 1