Contemporary Role of Open Surgery in the Management of High-Grade Renal Injury

Purpose of Review: This review focuses on latest developments in kidney trauma management and the role of open surgical intervention. Recent Findings: In the last decade, there had been an obvious drift towards conservative, non-operative, management of kidney trauma, undoubtedly when it is secondary to blunt trauma. Improved imaging, minimally invasive interventions, advancements including stent and nephrostomy insertions for urine extravasation, and angiography with angioembolization for acute or impending arterial bleeding have narrowed the necessity for open surgery, even when dealing with high-grade kidney injury. Still, open surgical intervention has its essential role, predominantly in the severely bleeding-unstable patient, high-grade penetrating kidney trauma, patients with concomitant intra-abdominal injuries, and the cases of non-operative surgical approach failure. Summary: Open surgical management has a contracted but still critical share in kidney trauma management. Being alert to the indications for open intervention and mastering the different surgical techniques could impact kidney salvageability and long-term clinical outcome.