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Intraoperative fluid management in laparoscopic live-donor nephrectomy: Challenging the dogma

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Abstract

Background

Patients undergoing laparoscopic live donor nephrectomy (LLDN) commonly receive large amounts of fluid intraoperatively to counter the negative effects of pneumoperitoneum on renal function. Our aim is to demonstrate that a low-volume fluid management strategy does not adversely affect donor or recipient outcomes.

Methods

Fifty-two patients underwent LLDN between December 2000 and January 2004. Data were collected in prospective databases, and augmented with retrospective medical record review. Donors were divided into two groups: the fluid-load group (n = 24) received >10 ml/kg/h of intravenous crystalloids intraoperatively, while the fluid-restriction group (n = 28) received <10 m/kg/h.

Results

Donors in the fluid-restriction group had a lower intraoperative urine output. There were no differences in postoperative creatinine levels (117.5 μmol/L vs 121.5 μmol/L, p = 0.8) or complications (4.2% vs 7.1%, p = 0.9). In the recipients, there were no differences in postoperative creatinine levels up to 12 months, incidence of delayed graft function (18% vs 10%, p = 0.7) or acute rejection (9% vs 5%, p = 1.0) between groups.

Conclusion

Lower volume fluid management strategies in LLDN do not appear to worsen recipient outcomes nor are they detrimental to the donors.

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Acknowledgments

Disclosure. This work was supported by an unrestricted educational grant from Tyco Healthcare.

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Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Montreal, Quebec, Canada, H3G 1A4

    S. Bergman, L. S. Feldman, M. Anidjar, M. C. Vassiliou, C. G. Andrew, D. D. Stanbridge & G. M. Fried

  2. Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Montreal, Quebec, Canada, H3G 1A4

    S. Bergman, L. S. Feldman, M. Anidjar, M. C. Vassiliou, C. G. Andrew & G. M. Fried

  3. Department of Anesthesia, McGill University Health Centre, 1650 Cedar Avenue, Montreal, Quebec, Canada, H3G 1A4

    F. Carli

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  1. S. Bergman
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  2. L. S. Feldman
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  3. F. Carli
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  4. M. Anidjar
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  5. M. C. Vassiliou
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  6. C. G. Andrew
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  7. D. D. Stanbridge
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  8. G. M. Fried
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Correspondence to L. S. Feldman.

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Bergman, S., Feldman, L.S., Carli, F. et al. Intraoperative fluid management in laparoscopic live-donor nephrectomy: Challenging the dogma . Surg Endosc 18, 1625–1630 (2004). https://doi.org/10.1007/s00464-004-8811-3

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  • DOI: https://doi.org/10.1007/s00464-004-8811-3

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