Altering the Approach: Open Minimally Invasive Renal Transplant in Obese Patients Through the Anterior Rectus Sheath.

OBJECTIVE: To retrospectively analyze the wound issues for obese renal transplant patients, as well as post-transplant outcomes including graft and patient survival, hypothesizing improvement over the standard approach. As the obese population has expanded, minimally invasive renal transplant techniques have attempted to improve the issues of complications related to wounds and hernias. The anterior rectus sheath approach, which facilitates a minimal incision, has been adopted at our center for all renal transplants, including obese patients. METHODS: Between January 1, 2011 and December 31, 2014, 166 renal transplants were performed at the Charleston Area Medical Center with the new approach adopted in November 2012. Of the extraperitoneal transplants, 71 adult patients were classified as morbid/severe (≥35) or obese (30-34.9) by body mass index. Demographics, perioperative results, and outcomes were retrospectively collected for the conventional (CON) and anterior rectus sheath (ARS) approaches until August 21, 2015. RESULTS: The ARS and CON groups comprised 40 of 71 (56%) and 31 of 71 (44%) patients, respectively. The majority of demographics and perioperative data indicated no significant statistical differences between procedures (P < .05). Wound complications, incision length, operative time, and glomerular filtration rate at 6 and 12 months were significantly different. Multivariate calculations indicated procedure as the only variable expected to affect wound healing in obese patients. CONCLUSION: For obese patients, the ARS approach was shown to be an effective option that reduced wound complications and operative times. This easily adopted approach provides the obese and morbidly obese with comparable overall graft outcomes and significant improvement on wound complications.

First experience: Open small incision rectus sheath approach renal transplant: A case series.

BACKGROUND: Prevention of wound complications is an important goal in surgery, and reduction of modifiable risks factors are an important step towards protecting patients from further complications. Renal transplantation has sought to be more inclusive giving access to transplantation to complex patient populations, many of which have an increased risk of complications specifically obese recipients. Surgical techniques continue to advance and may contribute to reducing complications. We hypothesized that the Anterior Rectus Sheath (ARS) Approach would provide an open transplant with minimal damage and less wound complications, including fluid collections such as lymphoceles, when compared to the conventional technique (CON) with equivalent graft function and survival. MATERIALS AND METHODS: The ARS approach was adopted at our center in November of 2012. Medical records for 44 patients that underwent kidney transplantation at our Center between May 1, 2012 and March 31, 2013 were reviewed with data collected up to August 2015. Two were excluded (2 intraperitoneal transplants), leaving 22 in the ARS group and 20 in the CON group. RESULTS: Demographics, data, and perioperative factors were found to be similar, but operative and post-operative findings indicated significant differences between the groups. Significant reductions of wound complications, including fluid collections, were observed and operative time, incision length, and drain usage were improved with the ARS technique. Secondary outcome assessing overall patient outcomes showed no significant difference. CONCLUSION: This retrospective review case series quantified that this easily adopted modification of the conventional transplant technique is a safe, effective, and swift approach to renal transplantation with favorable graft results and improved surgical outcomes with less post-operative wound complications.