Modified Renal Autotransplantation in Children with Renovascular Hypertension
Hypertension in children is often associated with impaired blood flow through the kidneys as a result of the strictures of main trunks of renal arteries. Kidney autotransplantation with kidney implantation into iliac vessels is well recognized treatment for hypertension and arterial nephropathy in children, especially in cases involving complex reconstruction of arteries, or the need of reimplantation of artery outside the pathologically changed aorta.The aim of the study was to compare a group of children operated using classic and modified kidney autotransplantation technique with rotation of the kidney by 180 degrees.Material and methods. For the first time we performed such operation in 2001 in order to obtain favorable arrangement of anastomosed vessels and to avoid the need of shortening and anastomosing of the urether. In patients requiring reconstruction of arteries in the "back table" we usually used the classic method, but in cases with difficulty in matching short vessels, the modified technique was used even after "ex-situ" reconstructions.The subject of the report are 11 children aged from 8 years to 17 years in which we performed a modified kidneys autotransplantation with its rotation. In retrospective analysis we observed: function of operated kidney, occurrence of postoperative complications, need for reoperations or other vascular or urological interventions, degree of normalization of blood pressure.Results. During post operative observation we found no difference in the amount of vascular complications between the two groups. We observed difference in the occurrence of urological complications for the benefit of the group after the rotation of transplanted kidneys. At the same time using this method of operation, we obtained normalization of blood pressure and the possibility of significant reduction or discontinuation of pharmacological treatment. In all patients, we observe normal function of transplanted kidneys, except for one that was removed.Conclusions. Modified method of kidney transplantation with rotation seems to be a good and effective method of treatment in cases of difficulties with vascular and urethral matching. It is safe, reducing urological complications, alternative for classical operations.
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