The Approach by Midline Incision for Extraperitoneal Kidney Transplantation

Abstract No data are available on incisional hernia in renal transplant recipients using a midline incision. This study evaluated the incidence of abdominal wall incisional hernia, comparing two surgical approaches: midline and J-shaped incisions. Methods Between 1991 and 2005, 415 consecutive patie...

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Veröffentlicht in:Transplantation proceedings 2007-12, Vol.39 (10), p.3077-3080
Hauptverfasser: Filocamo, M.T, Zanazzi, M, Li Marzi, V, Marzocco, M, Guidoni, L, Dattolo, E, Nicita, G
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Sprache:eng
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Zusammenfassung:Abstract No data are available on incisional hernia in renal transplant recipients using a midline incision. This study evaluated the incidence of abdominal wall incisional hernia, comparing two surgical approaches: midline and J-shaped incisions. Methods Between 1991 and 2005, 415 consecutive patients underwent renal transplantation: between 1991 and 1997, 139 patients through a lateral incision; between 1997 and 2005, 137 of 276 renal trasnsplant patients via a midline incision, and 139 via a J-shaped incision. We evaluated the incidence of incisional herniae in these patients. Analyzed factor risks included: age, sex, body mass index, diabetes, reoperation, lymphocele, dialysis time, underlying renal disease, and immunosuppressive therapy. Results During follow-up, 15 patients of 415 transplantations were dead or lost to follow-up. Incisional herniae were identified in 12 cases of 132 (9%) between 1991 and 1997. Between 1997 and 2005 we identified 3 of 133 (2.2%) patients who underwent a midline incision and 15 of 135 (11.1%) who received a J-shaped incision ( P = .005). Comparing midline and J-shaped incisions before and after 1997, the incidence reduction was significant ( P = .01). Comparing the incidence among patients treated with J-shaped incision before versus after 1997, the increased incidence was insignificant ( P = .6). Multivariate analysis found the most important risk factor was obesity followed by polycystic kidney disease, reoperation, wound infection, and mycophenolate mofetil therapy. Conclusions Our data showed an advantage of a midline incision. Strategies to prevent surgical complications, such as abdominal wall relaxation and poor cosmetic results, are needed; the midline incision may be a possible alternative to address this complication.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2007.09.038