Retroperitoneoscopic nephrectomy has better perioperative outcomes than transperitoneal laparoscopic nephrectomy in obese patients

Objective: This retrospective, case-controlled study compares the operative outcomes of retroperitoneoscopic nephrectomy (RN) and transperitoneal laparoscopic nephrectomy (TLN) in obese patients. Materials and Methods: A total of 202 operations, including 114 radical and 88 simple nephrectomies were identified from our prospectively collected institutional laparoscopic nephrectomy database. Patients were stratified into 3 groups according to the World Health Organization's body mass index (BMI) classification: normal (Group 1-BMI <25 kg/m(2), n=68), overweight (Group 2-25 kg/m(2) <= BMI <30 kg/m(2), n=88) and obese (Group 3-BMI >= 30 kg/m(2), n=46). Furthermore, each group was divided into two subgroups according to the operation performed (RN or TLN). Perioperative parameters were compared statistically between the RN and TLN subgroups in all of the BMI-stratified categories. Results: The results for mean operative time (p<0.001, p=0.034 and p=0.005), estimated blood loss (p<0.001, p<0.001 and p=0.002) and length of hospital stay (p=0.005, p<0.001 and p<0.001) were all significantly in favor of RN in Groups 1, 2 and 3, respectively. The complication rate did not significantly differ between RN and TLN in the BMI-stratified groups. Conversely, the open conversion rate was significantly higher for TLN in Group 1 (p=0.024); this rate was similar for RN and TLN in Group 2 (p=0.22) and Group 3 (p=0.658). Conclusion: Retroperitoneoscopic nephrectomy has better perioperative outcomes in obese patients; these outcomes are similar to those seen in non-obese patients. However, both retroperitoneoscopic and transperitoneal laparoscopic operations can be safely performed, with the same complication and open conversion rates, in obese patients.