Barlas Ilhami Soykan, Aydogdu Ibrahim, Sinangil Ayse, Ucar Zuhal Atan, Koc Yener, Sardogan Ceyda, Akin Emin Baris
Department of Kidney and Pancreas Transplantation, Istanbul Bilim University Sisli Florence Nightingale Hospital, Istanbul, Turkey.
Department of Kidney Transplantation, Bezmialem Vakif University, Istanbul, Turkey.
Transplant Proc. 2019 Sep;51(7):2215-2220. doi: 10.1016/j.transproceed.2019.01.162.
Hand-assisted retroperitoneoscopic (HARP) donor nephrectomy prevents major complications, but incision site complications may be more frequent in hand-assisted approach. We evaluated long-term incisional complication rates and cosmetic outcomes after HARP donor nephrectomy in our series.
A total of 609 donors who underwent nephrectomy between February 2009 and June 2016 were invited for physical examination and face-to-face interview. A total of 209 donors (35.3%) participated to the study. Sex, age, body mass index (BMI), mean follow-up period, incision-related outcomes of cosmesis, and postoperative complications were evaluated. Body image scale (BIS) and cosmetic scale (CS) (scar test) questionnaires were applied. Higher cosmesis and body image scores indicated greater satisfaction.
A total of 191 donors had paramedian (91.4%), and 18 donors had Pfannenstiel incision (8.6%); 121 donors were female (57.9%). The donor mean age and BMI were 49.1 (SD, 1.8) years and 29.7 (SD, 5.1), respectively. Body mass index was significantly lower in the Pfannenstiel group (P < .001). The mean BIS score was 18.9 (SD, 1.8), and the CS questionnaire score was 19.3 (SD, 4,7). The BIS score was significantly better in donors with Pfannenstiel incisions (P < .001), but there was no statistical significance in CS score. The total rate of wound infection was 4.8%, and rate of incisional hernia was 4.8%. The rate of incisional hernia was more frequent in donors with paramedian incision (5.2%), but there was no statistical significance. Six donors (2.9%) required rehospitalization because of incision site complications.
Hand-assisted retroperitoneoscopic donor nephrectomy avoids intra-abdominal complications, but rate of incision site complications can be higher in hand-assisted procedure. The donors were convinced from the cosmetic outcome after HARP donor nephrectomy. The ones who had Pfannenstiel incision had better satisfaction according to BIS score.
手辅助后腹腔镜供体肾切除术可预防严重并发症，但手辅助入路的切口部位并发症可能更常见。我们评估了本系列手辅助后腹腔镜供体肾切除术后的长期切口并发症发生率和美容效果。
邀请2009年2月至2016年6月期间接受肾切除术的609名供体进行体格检查和面对面访谈。共有209名供体（35.3%）参与了本研究。评估了性别、年龄、体重指数（BMI）、平均随访期、切口相关的美容效果及术后并发症。应用了身体形象量表（BIS）和美容量表（CS）（瘢痕测试）问卷。美容和身体形象得分越高表明满意度越高。
共有191名供体采用旁正中切口（91.4%），18名供体采用Pfannenstiel切口（8.6%）；121名供体为女性（57.9%）。供体的平均年龄和BMI分别为49.1（标准差，1.8）岁和29.7（标准差，5.1）。Pfannenstiel组的体重指数显著较低（P <.001）。平均BIS评分为18.9（标准差，1.8），CS问卷评分为19.3（标准差，4.7）。采用Pfannenstiel切口的供体的BIS评分明显更好（P <.001），但CS评分无统计学意义。伤口感染总发生率为4.8%，切口疝发生率为4.8%。旁正中切口供体的切口疝发生率更高（5.2%），但无统计学意义。6名供体（2.9%）因切口部位并发症需要再次住院。
手辅助后腹腔镜供体肾切除术可避免腹腔内并发症，但手辅助手术的切口部位并发症发生率可能更高。供体对后腹腔镜供体肾切除术后的美容效果表示满意。根据BIS评分，采用Pfannenstiel切口的供体满意度更高。
