Laparoscopic Simple Nephrectomy - Not Always Simple

Objective: Nephrectomies for atrophic kidneys, especially those complicated by xanthogranulomatous pyelonephritis (XGPN), pose substantial surgical challenges due to severe fibrosis and inflammation affecting the renal hilum and surrounding tissues. This study evaluates the outcomes and complications associated with laparoscopic nephrectomy in such complex cases. Methods: This retrospective study reviewed 60 cases of laparoscopic nephrectomy for XGPN-affected atrophic kidneys at Civil Hospital Ahmedabad between 2014 and 2024. The study analyzed intraoperative challenges, postoperative outcomes, and complications. Results: In 5 cases (8.3%), severe inflammation necessitated conversion to open surgery. Histopathology confirmed XGPN in all patients. Complications occurred in 7 patients (11.7%), with no cases of postoperative fistula, abscess, or dialysis requirement. Conclusions: Laparoscopic nephrectomy remains viable for XGPN-affected atrophic kidneys, though the complexity of the procedure demands thorough preoperative planning and readiness for open conversion. Key words: simple, nephrectomy, XGPN, open, surgery, laparoscopic, atrophic, fistula, dialysis, outcome, conversion