The extraperitoneal bilateral nephrectomy through an upper abdominal transverse incision was devised for renal recipients and for those chronic renal failures with malignant hypertension.
The extraperitoneal bilateral nephrectomy through upper abdominal transverse incision has several merits such as good exposure of the operative fields, absence of respiratory or circulatory distress during surgery, excellent wound healing, less surgical stress, and absence of intraperitoneal contamination by the infected kidneys.
Two cases of regularly hemodialyzed patients with malignant hypertension were nephrectomized bilaterally by this new approach. Their hypertension was not controlled by hemodialysis, nor by restriction of sodium and water intake, nor by the antihypertensive medicine. The renal and peripheral venous blood sample analysis demonstrated high renin and no erythropoietin activities.
After uneventful postoperative courses, their blood pressure was lowered gradually to the normotensive level without antihypertensive medicine. Aggravation of anemia was not observed.
Some discussions regarding the indication for bilateral nephrectomy, the comparison between this new approach and the other operative methods, the pre-and post-operative management of the bilateral nephrectomy, the blood pressure response and the erythropoietic activity following nephrectomy were done.
