*Purpose: Purpose: The anterior rectus sheath (ARS) approach to kidney transplantation (KT) involves a small skin incision to incise the ARS and medially retract rectus musculature, exposing the extraperitoneal space without cutting muscle. Retrospective literature demonstrated decreased wound-related complications compared to the standard Gibson approach (GA). Herein we present preliminary results from a randomized double-blind controlled trial comparing approaches for patients with at least 6 months follow-up.

*Methods: Methods: Patients above age 18 without prior ipsilateral KT were enrolled. Surgeons randomized patients intraoperatively. Participants were not given additional incision-specific details apart from the fact that they were receiving one of two muscle splitting approaches. Data collection and analysis were blinded. Student’s t-test and Chi-square were used to compare continuous and categorical data, respectively. The primary endpoint was wound complications and associated admissions; secondary endpoints were post-operative pain and analgesic requirements.

*Results: Results: 59 ARS and 56 GA patients were reviewed (Table 1). Demographic data, total operative and anastomotic time, benched kidney volumes, pain scores and length of stay did not differ between groups. The ARS group had smaller incisions (p<0.01) and potentially less inpatient narcotic use (p=0.053). 3 patients in the ARS and none in the GA group had a wound related complication (p=0.34). One ARS patient was re-admitted for fascial dehiscence, and two had superficial skin dehiscence requiring bedside skin re-approximation.

*Conclusions: Conclusions: At interim analysis of patients with 6 month follow up, wound related complications did not differ between the ARS and GA groups. Patients undergoing ARS may require less inpatient narcotic use despite having similar subjective reporting of pain.

« Back to 2021 American Transplant Congress