Hand-Assisted Nephrectomy Predisposes Incisional Herniation in Obese Living Donors

Barlas, İlhami Soykan; Aydoğdu, İbrahim; Sinangil, Ayşe; Uçar, Zuhal Atan; Koc, Yeney; Ecder, Tevfik; Akın, Emin Barış

doi:10.1016/j.transproceed.2019.02.042

Cited by 8 publications

(6 citation statements)

References 20 publications

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“…Obesity has previously been implicated in the development of IH in other surgical settings [18] [19] [20]; however, its role in IH after LDN has been less clear. While some studies suggest there is no difference in IH rates between obese and non-obese donors [21], others point toward obesity as a risk factor [22]. Our study provides further evidence that obesity is an independent risk factor contributing to IH formation after LDN, specifically in donors with a BMI > 30.…”

Section: Discussionsupporting

confidence: 51%

Incisional Hernia Development after Live Donor Nephrectomy: Impact of Surgical Technique

et al. 2022

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Background: Characteristics of incisional hernia (IH) formation following live donor nephrectomy (LDN) are not well defined. The goal of this study was to describe the incidence of IH within 3 years following LDN and identify risk factors contributing to their formation. Materials and methods: We performed a single center, retrospective review of all LDN between February 2013 to October 2018. Patients with and without IH were compared based on donor and operative variables. Data were analyzed using chi square tests with column proportions. Multivariable logistic regression with backwards elimination was used to evaluate the likelihood of IH based on potential risk factors. Results: Three hundred and one individuals underwent live donor nephrectomy. Twenty-eight patients (9.3%) developed an incisional hernia with median time to development of 7 months (range: 2-24 months). Obesity [Body Mass Index (BMI) ≥30], periumbilical hand port, and vertical infraumbilical hand port were associated with increased risk of IH development on univariate analysis. On multivariate analysis, obesity and periumbilical hand port location were persistent risk factors for IH. Conclusions: The incidence of IH following LDN is prevalent and associated with obesity and operative technique. Placing the hand port infraumbilical with a transverse fascial incision may reduce the risk of IH following LDN.

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Section: Discussionsupporting

confidence: 51%

Incisional Hernia Development after Live Donor Nephrectomy: Impact of Surgical Technique

et al. 2022

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“…The incidence of incisional hernia was higher after TP‐HALDN than RP‐HALDN (3.4% vs 0%) 27,28 . We do not believe that such difference may be related to donor characteristics, length of the procedures or post‐operative infections because gender distribution, age, and BMI were equivalent; furthermore, the duration of the operation and SSI was lower in the TP‐HALDN group.…”

Section: Discussionmentioning

confidence: 77%

“…27,28 We do not believe that such dif- may favor the development of incisional hernia as it represents a tension point of the abdominal wall. [27][28][29] As previously observed by Buell and colleagues, 30 We found that the length of the procedure was longer for RP-HALDN than TP-HALDN. However, a difference of about 11 minutes does not represent in our opinion a substantial advantage of TP-HALDN.…”

Section: Discussionmentioning

confidence: 95%

“…We do not believe that such difference may be related to donor characteristics, length of the procedures or post‐operative infections because gender distribution, age, and BMI were equivalent; furthermore, the duration of the operation and SSI was lower in the TP‐HALDN group. A plausible explanation is that the incision of the peritoneum combined with the hand‐port placement on the midline required for the TP technique may favor the development of incisional hernia as it represents a tension point of the abdominal wall 27-29 …”

Section: Discussionmentioning

confidence: 99%

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Outcomes and surgical complications following living‐donor renal transplantation using kidneys retrieved with trans‐peritoneal or retro‐peritoneal hand‐assisted laparoscopic nephrectomy

Favi

Iesari

Catarsini

et al. 2020

Clinical Transplantation

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The best minimally invasive procedure for living-donor kidney retrieval remains debated. Our objective was to assess trans-peritoneal (TP) and retro-peritoneal (RP) hand-assisted laparoscopic donor nephrectomy (HALDN). In this single-center retrospective study, we analyzed results from 317 living-donor renal transplants (RT) performed between 2008 and 2016. Donor and recipient outcomes were compared between TP-HALDN (n = 235) and RP-HALDN (n = 82). Conversion to open nephrectomy (0.4% vs 0%; P = 1.000), intra-operative complications (1.7% vs 1.2%; P = 1.000), and 1-year overall post-operative complications (11.9% vs 17.1%; P = .258) rates were similar in TP-HALDN and RP-HALDN. Overall surgical site infections were higher in RP-HALDN (6.1% vs 1.7%; P = .053), whereas incisional hernias were only recorded following TP-HALDN (3.4% vs 0%; P = .118). The duration of the procedure was 11-minute shorter for TP-HALDN than RP-HALDN (P < .001) but extraction time was equivalent (2, IQR 1.5-2.5 minutes; P = 1.000). RT following TP-HALDN and RP-HALDN showed comparable one-year death-censored allograft survival (97% vs 98.8%; P = .685), primary non-function (0.4% vs 0%; P = .290), delayed graft function (1.3% vs 4.9%; P = .077), and urological complications (2.6% vs 4.9%; P = .290) rates. In our series, donor and recipient outcomes were not substantially affected by the approach used for donor nephrectomy. TP-HALDN and RP-HALDN were both safe and effective. K E Y W O R D S complications, hand-assisted laparoscopic nephrectomy, kidney transplantation, minimally invasive surgery, organ donation, outcomes, surgical training, ureteric leakage, ureteric stenosis, warm ischemia time How to cite this article: Favi E, Iesari S, Catarsini N, et al. Outcomes and surgical complications following living-donor renal transplantation using kidneys retrieved with transperitoneal or retro-peritoneal hand-assisted laparoscopic nephrectomy.

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“…A randomized clinical trial with a 5-year follow-up of 30 patients after PRA for unilateral adrenalectomy did not report any hernias (8) whereas a retrospective study of 560 PRA procedures mentions one case of hernia (10). On the other hand, IH after ATA or LTA have been discussed (13,14) as well as after other types of retroperitoneal surgery (e.g., nephrectomy) (15)(16)(17)(18). We report an IH, a rare complication of PRA requiring surgical intervention and highlight four different aspects from our own experience.…”

Section: Discussionmentioning

confidence: 99%

Hernia after retroperitoneoscopic adrenalectomy, case report

Magyar

Nebiker

2020

Gland Surg

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We report the first case of a previously undocumented complication after posterior retroperitoneal adrenalectomy (PRA). Extensive diagnostic procedures for persisting abdominal pain led to diagnosis of an incisional hernia (IH) approximately 2.5 years after surgery for a pheochromocytoma of the right adrenal gland. Thus, IHs need to be recognized as a potential complication after PRA, particularly if the symptoms are non-specific. The differential diagnosis of an IH after PRA includes a type of spontaneous lumbar hernia due to a pre-existing weakness of the abdominal wall however the treatment for both type of hernias is similar by mesh repair. A possible risk factor for IH after PRA might be obesity, due to different factors including difficulties in closing the fascia in depth under subcutaneous tissue.

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Hand-Assisted Nephrectomy Predisposes Incisional Herniation in Obese Living Donors

Cited by 8 publications

References 20 publications

Incisional Hernia Development after Live Donor Nephrectomy: Impact of Surgical Technique

Incisional Hernia Development after Live Donor Nephrectomy: Impact of Surgical Technique

Outcomes and surgical complications following living‐donor renal transplantation using kidneys retrieved with trans‐peritoneal or retro‐peritoneal hand‐assisted laparoscopic nephrectomy

Hernia after retroperitoneoscopic adrenalectomy, case report

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