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Anterior Rectus Sheath Approach for Renal Transplant: An Open Minimal Incision with Decreased Wound Complications.

S. Phillips,1 S. Hill,1 L. Lipscomb,1 B. Sankari,2 S.-C. Chueh,2 J. Africa.2

1Charleston Area Medical Center, Charleston, WV
2Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.

Meeting: 2016 American Transplant Congress

Abstract number: C243

Keywords: Kidney transplantation, Morbidity, Outcome, Post-operative complications

Session Information

Date: Monday, June 13, 2016

Session Name: Poster Session C: Poster Session 1: Kidney Complications-Other

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

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Preventing wound complications is an important goal in all surgery. The reduction of modifiable risk factors, like surgical approach, is an important step towards protecting patients from further morbidity. We hypothesized that the Anterior Rectus Sheath approach (ARS), which was adopted in Nov. 2012 for renal transplant recipients, would provide a minimally invasive, open transplant with less wound complications and equivocal graft function and survival when compared to the standard conventional technique (CON). Between Jan. 1, 2011 and Dec. 31, 2014, 166 patients underwent kidney transplantation at our center. Six patients were excluded (4 intraperitoneal and 2 simultaneous native nephrectomy), leaving 84 in the ARS and 76 in the CON group. Retrospectively, demographics and perioperative factors were found to be similar, but operative and post-operative findings indicated significant differences (Table 1). Regression analysis also supported benefit of new approach. The ARS facilitates a small incision and minimizes the invasiveness of the open procedure. We concluded that this easily adopted modification of the conventional transplant technique is a safe, effective, and swift approach. Our results indicate favorable function with improved outcomes and lower post-operative wound complications.

 

#

ARS

CON

P value

Wound Complications

Skin dehiscence
Fascial dehiscence
Infection or SSI
Incisional Hernia
Internal Hernia
Ischemic Bowel
Fluid Collections
           

26

4
8
11
12
1
2
12

6 (7.1%)

0 (0%)
1 (1.2%)
2 (2.4%)
2 (2.4%)
1 (1.2%)
0 (0%)
4 (4.8%)

20 (26.3%)

4 (5.3%)
7 (9.2%)
9 (11.8%)
10 (13.2%)
0 (0%)
2 (2.6%)
8 (10.5%)

0.001

0.05
0.03
0.03
0.01
>.99
0.22
0.23

Delayed Graft Function

12

7 (8.4%)

5 (6.7%)

0.67

Acute Rejection

11

6 (7.1%)

5 (6.6%)

0.89

Graft Function (GFR)
6 months
12 months

 
148
126

 
64.6 (22,124)
68.4 (23,121)

 
55.4 (21,116)
59.9 (27,116)

 
0.01
0.04


Operative Time,
  Deceased Donor

145

166.3 (110,283)

232.6 (171,386)

<.0001 

Incision Length

155

9.49 (5,14)

17.8 (12,27)

<.0001

Hospitalization length

160

6.8 (4,28)

6.8 (4,22)

0.93


Graft loss (total)

17

7 (8.3%)

10 (13.2%)

0.52

Patient Death

12

4 (4.8%)

8 (10.5%)

0.23

CITATION INFORMATION: Phillips S, Hill S, Lipscomb L, Sankari B, Chueh S.-C, Africa J. Anterior Rectus Sheath Approach for Renal Transplant: An Open Minimal Incision with Decreased Wound Complications. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Phillips S, Hill S, Lipscomb L, Sankari B, Chueh S-C, Africa J. Anterior Rectus Sheath Approach for Renal Transplant: An Open Minimal Incision with Decreased Wound Complications. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/anterior-rectus-sheath-approach-for-renal-transplant-an-open-minimal-incision-with-decreased-wound-complications/. Accessed March 6, 2021.

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