Bilateral open transperitoneal cyst reduction surgery for autosomal dominant polycystic kidney disease

Purpose: We reviewed our experience with open transperitoneal bilateral renal cyst reduction surgery in patients with symptomatic autosomal dominant polycystic kidney disease to define perioperative morbidity and mortality, and to suggest that others consider this mode of therapy when more conservative methods fail to provide relief from pain or early satiety. Materials and Methods: A total of 28 patients underwent 30 transperitoneal bilateral renal cyst reduction decompression operations between May 1987 and June 1996. Ten procedures included surgical treatment of concomitant liver cysts (8 by liver cyst marsupialization and 2 by partial hepatic resection). Records were reviewed for hospital stay, perioperative morbidity, changes in renal function and hypertension control. Results: Hospitalization averaged 9 days. Treatment of hepatic cysts, age and renal insufficiency did not extend hospitalization. A transient reduction in renal function occurred after 20 procedures. The most frequently encountered perioperative morbid events were ileus in 4 patients and cardiac arrhythmias in 3. The most significant complications were myocardial infarction in 1 patient and fatal adult respiratory distress syndrome after partial liver resection in another. Preoperative renal insufficiency, age and treatment of hepatic cysts were not associated with increased morbidity. Six patients had improvement in hypertension and none had sepsis. Conclusions: Bilateral transperitoneal renal cyst reduction surgery is a relatively safe and effective treatment for individuals with symptomatic polycystic kidney disease in whom more conservative therapies have failed.