Transplant nephrectomy with peritoneal window: Georgetown University experience

Peritoneal drenaj ile transplant nefrektomi: Georgetown Üniversitesi sonuçları

Rachel Rubinz, oya M. anda, erik ander, william cor, evan mic, jack moo, Matthew Cooper, Seyed Ghasemian

Abstract

Objective: Transplant nephrectomy is a technically challenging procedure with high complication rates. Morbidity and mortality are mostly due tohemorrhage or infection and are reported to be 17-60% and 1-39%, respectively. The most common surgical technique for transplant nephrectomyis sub-capsular, extraperitoneal approach which may result in fluid accumulation and subsequent super-infection. We report that intraperitoneal approach, after assuring hemostasis of the transplant pedicle, allows for passive drainage, decreases hematoma formation and minimizes the subsequentinfection risk in the nephrectomy bed.Material and Methods: From July 2009 to July 2014 a total of 38 transplant nephrectomies were performed using the intraperitoneal window technique at Georgetown University MedStar Transplant Institute (MGTI). Data was collected retrospectively.Results: Average age at the time of transplant nephrectomy was 43.9 ± 14.3, and the majority were male (55.3%). Mean time to nephrectomy was 71.7± 67.4 months following transplantation. Indications for nephrectomy included pain, hematuria, fever, and recalcitrant rejection. Average operativetime was 97.1 ± 28.9 minutes, average blood loss was 172.5 ± 213.6 mL. A total of 9 (24%) complications occurred. Postoperative blood transfusion wasthe most common complication (15.7%) followed by 2 (5.3%) re-interventions; one take back for hematoma and one percutaneous drain placement forsymptomatic fluid collection. We had no infection, postoperative sepsis, ICU admissions, or mortality.Conclusion: Transplant nephrectomy with peritoneal window is a technique with better results compared to the literature. An opening between thetransplant cavity and the peritoneum allows for passive drainage of fluid and minimizes the risk of hematoma and abscess formation. This approachdoes not add significant time to the operation, furthermore it may decrease morbidity and mortality by reducing overall complications, namely hematoma formation and infection, which overall decreases rates of re-interventions and length of hospital stay

Özet

Giriş ve Amaç: Transplant nefrektomisinin morbidite ve mortalitesi %60 ve %39’a kadar çıkmakta olup genellikle kanama, enfeksiyon veya sepsise bağlı gelişmektedir. En çok kullanılan teknik subkapsüler, ekstraperitoneal yaklaşımdır. Bu yaklaşım seroma ya da hematom birikimini, dolayısıyla enfeksiyon riskini yükseltebilmektedir. Gereç ve Yöntem: Temmuz 2009-Temmuz 2014 tarihleri arasında, Georgetown Üniversitesi MedStar Transplant Enstitüsü (MGTI)’nde 38 transplant nefrektomi olgusu gözden geçirildi. Retrospektif data analizi uygulandı. Bulgular: Toplam 9 (%24) komplikasyon gelişti. Transfüzyon en sık görülen komplikasyon idi (%15,7) ve 2 (%5,3) hastaya yeniden girişim yapıldı. Enfeksiyon, sepsis, yoğun bakım yatışı ya da ölüm gözlenmedi. Sonuç: İntraperitoneal tekniğin pasif drenaj ve/veya absorbsiyon yolu ile hematom ya da enfeksiyon oluşumunu, dolayısıyla mortalite ve morbiditeyi azalttığı görüşündeyiz.