BACKGROUND: The preferred technique for kidney placement in SPK is intraperitoneal through a midline incision, as it is easy and fast to be performed. However, there are some disadvantages with this technique, such as difficulty with kidney graft biopsy due to bowel interposition and, although rare, the potential for kidney hilum kinking or twisting.

OBJECTIVE: To show the results of retroperitoneal vs. intraperitoneal placement of the kidney graft with different surgical techniques.

MATERIALS AND METHODS: We retrospectively evaluated all SPK performed in our institution and divided patients in three groups: intraperitoneal placement of kidney graft through a midline incision (Group, technique A), extraperitoneal placement of kidney graft through a J-shaped incision (Group, technique B) and extraperitoneal placement of the kidney graft through a midline incision (Group, technique C). Pancreas was placed intraperitoneally through a midline incision in all cases. We compared groups for patient and kidney graft survival, surgical times and complications.

RESULTS: A total of 105 SPK were performed during the study period. Five cases were excluded due to lack of complete surgical records. Of the cases included in this study, 41 (41%) were performed with technique A, 45 (45%) with technique B, and 14 (14%) with technique C. Patients characteristics were similar between groups. Surgical times were longer in group B. Two kidneys were lost in group A due to graft rotation at the hilum level with consequent graft necrosis, at 14 days and 2 years after transplant respectively, and in one case a kinking of the artery due to kidney ptosis required surgical treatment. Three cases of lymphocele required a laparoscopic peritoneal window as treatment in groups B and C. US-guided percutaneous kidney biopsy could not be performed in five cases due to visceral interposition in group A only. There were no differences in patient or kidney graft survival between groups.

CONCLUSION: Although the incidence of lymphocele that required surgical treatment was higher, extraperitoneal placement of the kidney graft in SPK prevented vascular kinking and malrotation at its hilum level with subsequent graft loss, and allowed an easier access for kidney graft percutaneous biopsy. Extraperitoneal kidney graft placement through a midline incision showed equal surgical times compared to intraperitoneal kidney graft placement.

CITATION INFORMATION: Maraschio M, Alcaraz A, Giordano Segade E. Extraperitoneal Placement of the Kidney Prevents Graft Vascular Kinking or Rotation in Simultaneous Pancreas-Kidney Transplant (SPK). Am J Transplant. 2016;16 (suppl 3).

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