What is Open Nephrectomy

Open nephrectomy is surgery to remove a kidney through the side or front of the abdomen. You may have surgery to remove:

• The entire kidney and some surrounding structures (radical nephrectomy).
• Only the damaged or diseased part of the kidney (partial nephrectomy).

You may need this surgery if:

• Your kidney is severely damaged from disease, infection, or cancer.
• You were born with an abnormal kidney.
• You are donating a healthy kidney.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to nerves, tissues, or other body structures near the kidney.
• Lung infection (pneumonia).
• Kidney failure, if a problem develops in the other kidney.
• A blood clot that forms in the leg and travels to the lung (pulmonary embolism).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• You may be given antibiotic medicine to help prevent infection. If so, take the antibiotic as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Your health care provider may instruct you to do breathing exercises before the procedure to help prevent pneumonia. Do these exercises as directed.
• You may need to have your blood drawn (type and cross) in case you need to receive blood (transfusion) during the procedure.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic).
• A tube will be inserted through your urethra into your bladder (urinary catheter). This will drain urine during the procedure.
• Your abdomen will be cleaned with a germ-killing (antiseptic) solution.
• An incision will be made in the front or side of your abdomen.
• The muscles, fat, and tissues under your skin will be split to allow access to your kidney.
• If you are having a radical nephrectomy:
  • Part of the tube that moves urine from your kidney to your bladder (ureter) will be removed.
  • All of the blood vessels that attach to your kidney will be separated and tied off.
  • Your kidney will be removed. Nearby lymphatic tissue will also be removed. Lymphatic tissue contains cells that are part of the body’s disease-fighting (immune) system.
• If you are having a partial nephrectomy, the diseased or damaged part of your kidney will be removed.
• A small tube (surgical drain) may be placed near the incision to drain extra fluid from the surgical area.
• Your incision will be closed with stitches (sutures) or staples.
• A bandage (dressing) will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• You will be given pain medicine as needed.
• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• Your fluid intake and urine output will be monitored.
• You will be encouraged to do breathing exercises.
• You may have a liquid diet at first. You will most likely return to your usual diet if you do not have any nausea.
• Your IV will be removed when you are eating well and you no longer need IV pain medicine or fluids.
• You will be encouraged to walk as soon as you can. Your health care providers will help you.
• Your urinary catheter will be removed after 1-2 days.
• Your surgical drain will be removed after a few days when only a small amount of fluid is draining from it.

Summary

• Open nephrectomy is surgery to remove a kidney through the side or front of the abdomen.
• In radical nephrectomy, the entire kidney is removed. In partial nephrectomy, only the damaged or diseased part of the kidney is removed.
• Before surgery, follow instructions from your surgeon about eating and drinking.
• This procedure is done under general anesthesia. This means that you will be given a medicine to make you fall asleep (general anesthetic).
• You will stay in the hospital for a few days after the procedure.

Open Nephrectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain in your side and abdomen. Pain may be worse when you cough or breathe deeply.
• Sore and weak muscles. It may be difficult to get up if you are sitting or lying down.
• Trouble finding a comfortable sleeping position.
• Numbness in the area around your incision.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Avoid using NSAIDs regularly over a long period of time. These include aspirin and ibuprofen. Taking NSAIDs often can eventually damage your remaining kidney.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), staples, skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

Activity

• Avoid activity that requires a lot of energy, such as running. Ask your health care provider what activities are safe for you during recovery and what activities you need to avoid.
• Rest as told by your health care provider.
• Avoid sitting for a long time without moving. Get up to take short walks every 1–2 hours. This is important to improve blood flow and breathing. Ask for help if you feel weak or unsteady.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.

Driving

• Do not drive until your health care provider approves.
• Do not drive or use heavy machinery while taking prescription pain medicine.

General instructions

• Do deep breathing exercises as told by your health care provider. These help to prevent lung infection (pneumonia).
• If you need to cough, try holding a pillow against your abdomen while coughing. This may help with discomfort.
• If lying down flat to sleep is uncomfortable, try sleeping in a chair instead until your incision heals more.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
  • Take over-the-counter or prescription medicine for constipation.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have pain that does not get better with medicine.
• You have a cough.
• You have shortness of breath.
• You vomit.
• You have constipation. Signs of constipation include having:
  • Fewer bowel movements in a week than normal.
  • Difficulty having a bowel movement.
  • Stools that are dry, hard, or larger than normal.
• You have diarrhea.

Get help right away if:

• You have severe pain.
• You have chest pain.
• You have difficulty breathing.
• You have redness, swelling, or pain around your incision.
• There is fluid or blood coming from your incision.
• Your incision is warm to the touch.
• There is pus or a bad smell coming from your incision.
• You cannot urinate.

Summary

• After the procedure, it is common to have pain in your side or abdomen.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Check your incision every day. Call your health care provider if you notice signs of infection.
• Follow instructions from your health care provider about exercise, driving, and general activities. Ask your health care provider what activities are safe for you.