Anatomy And Management Of Upper Moiety Vascular Variation In Children With Duplex Kidney

Purpose:To describe the upper pole vascular anatomy of duplex kidney and provide our experience with laparoscopic upper pole partial nephrectomy(LUPPN).Methods:A retrospective study was performed among patients with duplex kidney who underwent computed tomography angiography at one single institution,some of whom were subsequently treated with LUPPN.Ac-cording to imaging results and intraoperative findings,the arterial supply to the upper moiety of a duplex system was classified based on number and branching pattern.Results:A total of 84 children were included in the study.Twenty patients(23.8%)were managed conservatively and LUPPN in lateral position was performed in the others.All laparoscopic procedures were successfully completed as planned without conversion.No major intraoperative complications occurred.Of these patients,68 cases(73.1%)were supplied with one branch of the renal artery.The vascular anatomy of duplex kidney was classified into three patterns according to the variation of arteries.Themostcommon type was that the renal artery separated into two or more arteries near the renal parenchyma.The upper and lower renal poles were respectively supplied,which could be summarized as prehilar branching,a total of 71 sides(76.3%).The second type was the arteries from abdominal aorta or its branches,directly flowing to the upper renal pole,which was classified into the sub-renal artery,a total of 18 sides(19.4%).The others(4 sides,4.3%)were less common,and most of them were a combination of the above-mentioned two types,and one of them whose upper pole was supplied by branches of adrenal artery.Gender was not significantly associated with the vascular number(p=0.19)and the pattern of variation(p=0.83).Conclusions:LUPPN is an effective technique for children with duplex kidney.The upper renal moiety is mainly supplied by one branch of the renal artery and the most common pattern is perihilar arterial branching.Deter-mining vascular variation before surgery might be beneficial to avoid intraoperative hemorrhage and accidental vessel injury.