Introduction: Living kidney donor demographics, perioperative outcomes and data on renal function is recorded by national mandate. However other longer term and potentially significant surgical outcomes such as incisional herniation remain unquantified in the donor population.

Methods: A retrospective review of a database of 800 patients undergoing hand assisted laparoscopic donor nephrectomy (HALDN) and who had also undergone a minimum of one year follow up was undertaken. Episodes of incisional herniation were recorded from patient records and also from operative records held in the unit database. Incidence, time to herniation and potential patient (sex, age, BMI, smoking status) and surgical risk factors (retro v intraperitoneal, site of hand port, Clavien 3+ postoperative complications, wound infections, operative time, use of a surgical drain, open conversion) were identified and entered into a univariate and then multivariate logistic regression model.

Results: 43 (5.4%) patients developed an incisional hernia following HALDN. The median time to hernia diagnosis was 8 months (IQR 3 -12). 42/43 were at the site of the hand port. 41/43 underwent operative mesh repair (32 open 9 laparoscopic). Recurrence occurred in 2 patients (1 lap 1 open). The mean hospital stay post repair was 3.1 (SD 1.32) days compared to a post HALDN hospital stay of 3.9 days (SD 1.5) A higher BMI (27.3kg/m v 26.03 p=0.03), presence of postoperative chest infection(11% v 3%p=0.008), clavien 3+ complications (12% v 3.5% p=0.002), and a supraumbilical hand port position (8.84 v 3% p=0.001) were associated with incisional herniation on univariate analysis. On multivariate analysis only handport position (supra v infraumbilical ) was a significant predictive factor for incisional herniation (OR 3.8 95% CI 1.33 – 10.8)

Discussion: Incisional herniation (IH) is common following HALDN and is of an equivalent incidence to traditional open methods of nephrectomy. Surgical site infection (a commonly accepted risk factor for IH) is not implicated in this cohort. Post HALDN IH requires corrective surgery resulting in a postoperative hospital stay equivalent in duration to the original operation. The data presented – in addition to highlighting IH as significant source of morbidity – has identified an opportunity to reduce IH incidence through the more judicious use of supraumbilical fascial incisions.

« Back to 2015 American Transplant Congress