Nephropexy

Nephropexy involves fixing a floating kidney to the muscles of the abdominal wall. This surgery is performed in individuals with nephroptosis or floating kidney. 

Kidneys are located on each side of the spine in the abdomen. They play a vital role in filtering waste products from blood and producing urine.

Floating kidney or nephroptosis is a condition in which a person’s kidneys move down from their position in the abdomen when he/she moves from the supine (sleeping) to erect (standing) position. They may sometimes move back into position; however, it may not at times. This usually occurs due to insufficient support from fatty tissues around the kidney in women who are slim and young.

Usually, nephroptosis does not show any symptoms and may not need treatment. However, if symptoms occur, a nephropexy may be needed.

This surgery is recommended to individuals who show the following symptoms of nephroptosis:

• A sharp pain that moves to the groin area 
• High blood pressure 
• Blood in urine 
• Frequent urinary tract infections 
• Excessive protein in urine 
• Vomiting and nausea 
• A feeling of heaviness inside the abdomen

A surgeon may not recommend nephropexy if you do not have the symptoms of nephroptosis.

Before undergoing this surgery, you will need the following preparation:

• The healthcare provider will examine you thoroughly and order the following diagnostic tests: 
  • Ultrasound scan: The test helps to capture images of the mobile kidney inside the abdomen.
  • Doppler scan: This helps check the function of blood vessels inside the kidney.
  • Intravenous pyelography (IVP): This scan will show an image of your kidney in the standing position. 
• Your doctor should be aware of your lifestyle habits, including smoking and alcohol consumption. If you smoke, quitting this habit can ensure fast recovery after the surgery.
• Share a list of all the medicines that you take with your doctor, including prescribed and non-prescribed medications, minerals, herbs, vitamins, and supplements. 
• You will be asked to discontinue blood thinners (e.g., aspirin, ibuprofen, vitamin E, warfarin, and clopidogrel) for a few weeks before the surgery.
• Inform the doctor if you have had any recent health problems or have a history of allergic reactions to any food, adhesive tapes, iodine, latex, or skin cleaning solution.
• You will need to sign an approval or consent form to grant your permission for the procedure.
• You will have to fast for at least eight hours before the surgery.
• It is best to ask a family member or friend to take you to the hospital and bring you back home as you will not be able to drive after the surgery.

Once you reach the hospital, the hospital staff will provide you with a hospital gown. Nephropexy is performed using general anaesthesia to keep you relaxed and pain-free.

A tube will be inserted inside your stomach through your nose to provide you with medicine and food, and a small catheter (a thin, flexible tube) will be put into your bladder to drain urine. The surgery is then performed using either transperitoneal (through the lining of the abdominal cavity called peritoneum) or retroperitoneal (from behind the peritoneum) approach.

Transperitoneal approach 

The following steps are performed for this surgery: 

• You will be asked to lie on your left side on the operating table. 
• Once the anaesthesia starts to show it’s effect, the surgeon will make a small cut on your abdomen over the belly button. 
• Through this cut, he/she will insert an endoscope (a tube with a camera and light fitted to it) inside your abdomen. 
• Then, the surgeon will pass a needle inside your abdomen through the peritoneum. 
• The surgeon will further make a cut to expose the retroperitoneal space (the space behind the peritoneum) between your liver and colon. 
• He/she will completely detach your kidney. The other sections of the urinary system like the ureter (a tube that carries urine from the kidney to the bladder) and renal pelvis (a part of the kidney that functions as a funnel to pass urine into the ureter) are also exposed. 
• Thereafter, the surgeon will secure your kidney to your abdominal wall using sutures (stitches). He/she will use clips to fix the sutures in place.
• Once the kidney is affixed, the surgeon will place in a drainage tube inside your abdomen. This will help remove any accumulated fluids from the operated site.
• Finally, the surgeon will close your skin using absorbable stitches.

Retroperitoneal approach 

The following steps are performed for this technique:

• You will be asked to lie on your side on the operating table. 
• The surgeon will make a tiny cut on your abdomen at the belly button level. 
• He/she will use a special equipment called a balloon dissector to form a retroperitoneal space in your abdomen. 
• Next, the surgeon will expose your kidney by cutting the layers around it. 
• Once your kidney is exposed, the surgeon will cut the surrounding tissues to detach it completely. 
• He/she will then, fix your kidney to the muscles of your abdominal wall using adhesives. 
• The surgeon will put in a drainage tube inside the operated area, and close the surgical site with absorbable sutures.

The surgery lasts for about 45 minutes. You will need a hospital stay of about two to four days. A nurse will remove your drainage tube within a few days after the surgery. Your doctor may prescribe painkillers to relieve your pain after the surgery.

Before leaving the hospital, you will have to undergo a few diagnostic tests like ultrasound or IVP to check your healing.

Once you are home after the surgery, you will need the following care:

• Wound care: 
  • You may be allowed to take a shower but make sure to keep the wound area clean and dry. Gently pat dry it instead of rubbing.
  • Do not soak the wound until it is healed.
• Medicines: Take your prescribed pain medicines if you have pain.
• Activities: You can resume your activities four to six weeks after the surgery or once the surgeon allows you to.

When to see the doctor?

Visit or call your doctor right away if you have any of the following symptoms:

• Fever
• Nausea or vomiting 
• Constipation 
• Cough 
• Pus or bleeding from the operated area 
• Chest pain 
• Swelling 
• Foul smell from the wound
• Warmness around the surgical site
• Difficulty in breathing

This surgery is known to carry the following risks:

• Infection 
• Inability to correct nephroptosis 
• Bleeding 
• Blood clots in arms or legs
• Blood clots in the retroperitoneal space that cause swelling
• Puncture or injury to the intestine
• Nerve injury 
• Allergic reaction to anaesthesia 
• A burning or prickling sensation inside the muscle 
• Reoccurrence of symptoms

The surgeon will call you in the hospital again after a week and later in one, three, and six months and a year to monitor your condition.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.