Laparoscopic Transperitoneal Nephropexy without Using Intracorporeal Knot

Introduction: The downward displacement of the kidney (nephroptosis) when in orthostatic position may lead to incapacitating symptoms especially pain (which is believed to be due to temporary ischemia of the kidney); requiring surgical fixation of this organ to peritoneal muscles and ligaments. Laparoscopic is very efficient in these cases, either transretroperioneal or retroperitoneal bringing benefits to patients. We reported a successful case in which we performed the renal fixation without using intracorporeal knot. Report: A 65-year-old woman with pain in the right lumbar region. Excretory urography revealed a downward displacement of the right kidney when the position is changed from supine to orthostatic, as well as ipsilateral kink in the ureter. Transperitoneal nephropexy was performed with four trocars and suture was performed with a monofilamentary non-absorbable thread with the extremities tied to a polymer clip(Hem-olok® Pilling Weck) to fix the kidney. The operative time was 240 minutes with very little blood loss and after 3 days of hospital stay the patient was discharged. It was observed pain and paresthesia in right inferior member that improved with the use of gabepentin for a month. Conclusion: Laparoscopic nephropexy has encouraging outcomes (80-100%), which contrasts a little with the open technique, in spite of the fact that there is no prospective and randomized study comparing the two techniques. The kidney fixation with polymer clips (similar to what is used in the partial laparoscopic nephrectomy) may be a good alternative to avoid complications and failures in the treatment of the renal ptosis.