1
|
Calcerrada Alises E, Antón Rodríguez C, Medina Pedrique M, Berrevoet F, Cuccurullo D, López Cano M, Stabilini C, Garcia-Urena MA. Systematic review and meta-analysis of the incidence of incisional hernia in urological surgery. Langenbecks Arch Surg 2024; 409:166. [PMID: 38805110 DOI: 10.1007/s00423-024-03354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the incidence of incisional hernia in patients undergoing direct access to the abdominal cavity in urological surgery. METHODS We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed. RESULTS The total incidence in the 84 studies was 4.8% (95% CI 3.7% - 6.2%) I2 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%-11.8%) I2 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%-3.4%) I2 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%-4.8%) I2 76.96% and off-midline: 4.7% (95% CI 3.5%-6.4%) I2 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% - 23%) I2 77.39%. Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access. CONCLUSION The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen.
Collapse
Affiliation(s)
- Enrique Calcerrada Alises
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Sureste, Madrid, Spain.
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Cristina Antón Rodríguez
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
| | - Manuel Medina Pedrique
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
| | - Frederick Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Diego Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Manuel López Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
- Vall d'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cesare Stabilini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - Miguel Angel Garcia-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
| |
Collapse
|
2
|
Minkovich M, Gupta N, Liu M, Famure O, Li Y, Selzner M, Lee JY, Kim SJ, Ghanekar A. Impact of early surgical complications on kidney transplant outcomes. BMC Surg 2024; 24:165. [PMID: 38802757 PMCID: PMC11129490 DOI: 10.1186/s12893-024-02463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Kidney transplantation (KT) improves clinical outcomes of patients with end stage renal disease. Little has been reported on the impact of early post-operative surgical complications (SC) on long-term clinical outcomes following KT. We sought to determine the impact of vascular complications, urological complications, surgical site complications, and peri-graft collections within 30 days of transplantation on patient survival, graft function, and hospital readmissions. METHODS We conducted a single-centre, observational cohort study examining adult patients (≥ 18 years) who received a kidney transplant from living and deceased donors between January 1st, 2005 and December 31st, 2015 with follow-up until December 31st, 2016 (n = 1,334). Univariable and multivariable analyses were performed with Cox proportional hazards models to analyze the outcomes of SC in the early post-operative period after KT. RESULTS The cumulative probability of SC within 30 days of transplant was 25%, the most common SC being peri-graft collections (66.8%). Multivariable analyses showed significant relationships between Clavien Grade 1 SC and death with graft function (HR 1.78 [95% CI: 1.11, 2.86]), and between Clavien Grades 3 to 4 and hospital readmissions (HR 1.95 [95% CI: 1.37, 2.77]). CONCLUSIONS Early SC following KT are common and have a significant influence on long-term patient outcomes.
Collapse
Affiliation(s)
- Michelle Minkovich
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
| | - Nikita Gupta
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
| | - Michelle Liu
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
| | - Olusegun Famure
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
| | - Yanhong Li
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
| | - Markus Selzner
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
- Division of General Surgery, University Health Network, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Jason Y Lee
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
- Division of Urology, University Health Network, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - S Joseph Kim
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
- Division of Nephrology, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Anand Ghanekar
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada.
- Division of General Surgery, University Health Network, Toronto, Canada.
- Department of Surgery, University of Toronto, Toronto, Canada.
| |
Collapse
|
3
|
Mac Curtain BM, Qian W, Temperley HC, O'Mahony A, Ng ZQ, He B. Incisional hernias post renal transplant: a systematic review and meta-analysis. Hernia 2024; 28:301-319. [PMID: 37715026 DOI: 10.1007/s10029-023-02879-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE Incisional hernia (IH) post renal transplant (RT) is relatively uncommon and can be challenging to manage clinically due to the presence of the kidney graft and patient immunosuppression. This systematic review and meta-analysis synthesises the current literature in relation to IH rates, risk factors and outcomes post RT. METHODS PubMed, EMBASE, and Cochrane Central Registry of Controlled Trials (CENTRAL) were searched up to July 2023. The most up to date Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines were followed. Pertinent clinical information was synthesised. A meta-analysis of the pooled proportions of IH rates, the rates of patients requiring surgical repair and the rates of recurrence post RT are reported. RESULTS Twenty studies comprising 16,018 patients were included in this analysis. The pooled rate of IH occurrence post RT was 4% (CI 3-5%). The pooled rate of IH repair post RT was 61% (CI 14-100%). The pooled rate of IH recurrence after repair was 16% (CI 9-23%). Risk factors identified for IH development post RT are BMI, immunosuppression, age, smoking, incision type, reoperation, concurrent abdominal wall hernia, lymphocele formation and pulmonary disease. CONCLUSIONS IH post RT is uncommon and the majority of IH post RT are repaired surgically on an elective basis.
Collapse
Affiliation(s)
- B M Mac Curtain
- School of Medicine, University of Galway, Galway, Ireland.
- Dept. of Surgery, St John of God Subiaco Hospital, Subiaco, WA, Australia.
| | - W Qian
- Dept. of Surgery, St John of God Subiaco Hospital, Subiaco, WA, Australia
| | | | - A O'Mahony
- University Hospital Limerick, Limerick, Ireland
| | - Z Q Ng
- Dept. of General Surgery, Royal Perth Hospital, Perth, WA, Australia
| | - B He
- Renal Surgery and Transplant Unit, Austin Health, Melbourne, VIC, Australia
| |
Collapse
|
4
|
Fukuhara H, Nawano T, Kanda A, Tomosugi T, Okada M, Futamura K, Hiramitsu T, Takeda A, Tsuchiya N, Goto N, Narumi S, Watarai Y. Short-term outcomes of second kidney transplantation compared with those of first transplantation in Japanese patients: a single-center, retrospective, observational study. Clin Exp Nephrol 2023; 27:188-196. [PMID: 36318396 DOI: 10.1007/s10157-022-02290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Among patients who undergo kidney transplantation, a subsequent second kidney transplantation (TX2) is often necessary. The TX2 outcomes remain controversial, however, and only limited data are available on clinical outcomes of TX2 in Japanese patients. This study aimed to assess graft and patient survival rates of TX2 and compared these rates with those of first kidney transplantation (TX1) in Japanese patients. METHODS Of the 898 kidney transplantations performed between 2010 and 2019 at our institution, 33 were TX2. We performed survival analysis using weighted Kaplan-Meier analysis and Cox proportional hazards analysis with propensity score matching, specifically inverse probability of treatment weighting (IPTW). RESULTS Death-censored graft survival (DCGS) rates at 1, 3, and 5 years for the TX1 versus TX2 groups were 99.3, 97.9, and 95.0% versus 100, 96.0, and 91.2%, respectively. Overall survival (OS) rates at 1, 3, and 5 years for the TX1 versus TX2 groups were 99.4, 98.9, and 97.8% versus 100, 100, and 94.4%, respectively. Using the log-rank test, IPTW-weighted Kaplan-Meier curves showed no significant differences for TX1 versus TX2 in DCGS (p = 0.535) and OS (p = 0.302). On Cox proportional hazards analysis for TX2 versus TX1, the IPTW-adjusted hazard ratio (HR) for DCGS was 1.75 (95% CI, 0.28-10.9; p = 0.550) and for OS was 2.71 (95% CI, 0.40-18.55; p = 0.311). CONCLUSIONS For patients who require TX2, this treatment is an acceptable option based on the short-term outcomes data for DCGS and OS.
Collapse
Affiliation(s)
- Hiroki Fukuhara
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan. .,Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, Japan.
| | - Takaaki Nawano
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Akiko Kanda
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Toshihide Tomosugi
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Manabu Okada
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Kenta Futamura
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Takahisa Hiramitsu
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Asami Takeda
- Department of Nephrology, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, Japan
| | - Norihiko Goto
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Shunji Narumi
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Yoshihiko Watarai
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| |
Collapse
|
5
|
Nino-Torres L, Garcia-Lopez A, Patino-Jaramillo N, Giron-Luque F, Nino-Murcia A. Risk Factors for Urologic Complications After Kidney Transplantation and Impact in Graft Survival. Res Rep Urol 2022; 14:327-337. [PMID: 36196091 PMCID: PMC9527029 DOI: 10.2147/rru.s371851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Kidney transplantation (KT) is the best therapy for chronic kidney disease (CKD). Major urologic complications (MUCs) are the second etiology associated to morbidity and graft loss following KT, after rejection episodes. The objective of this study was to estimate the incidence, risk factors and impact on graft survival associated to urological complications in KT patients. Patients and Methods A retrospective cohort based on electronic patient files of kidney transplant recipients from Colombiana de Trasplantes was created for the period August 2008 to September 2019. Initiation of follow-up was defined as the date of transplantation up to 3 years post-transplantation. Incidence of ureteral stenosis, ureteral obstruction, and ureteral leak was measured. A logistic regression multivariate model was adjusted to determine the associated factors to MUCs (yes/no). Patient and graft survival time were analyzed using a Kaplan-Meier method. Results A total of 1584 KT patients were included in the cohort. MUCs were present in 195 (12.6%) KT patients. We found that dialysis duration (OR: 1.004; p = 0.02) remained significant for the incidence of MUCs in KT patients of deceased donors. Probability of graft and patient survival at 3 years of follow-up was 90.5% and 85.5%, respectively. No significant difference was found on graft and patient survival in KT patients with or without MUCs. Conclusion MUCs are frequent complications for KT. We did not observe significant differences in graft or patient survival according to the presence of MUCs. The identification of MUCs and risk factors may guide transplant teams for future surgical and clinical decisions.
Collapse
Affiliation(s)
- Laura Nino-Torres
- Department of Transplantation Surgery, Colombiana de Trasplantes, Bogotá, Colombia
| | - Andrea Garcia-Lopez
- Department of Transplantation Research, Colombiana de Trasplantes, Bogotá, Colombia
| | | | - Fernando Giron-Luque
- Department of Transplantation Surgery, Colombiana de Trasplantes, Bogotá, Colombia
| | - Alejandro Nino-Murcia
- Department of Transplantation Surgery, Colombiana de Trasplantes, Bogotá, Colombia
- Correspondence: Alejandro Nino-Murcia, Transplant Surgeon, Colombiana de Trasplantes, Av Carrera, 30 No. 47 A-74, Bogota, 111311, Colombia, Tel +57 3112499999, Email
| |
Collapse
|
6
|
Frailty predicts surgical complications after kidney transplantation. A propensity score matched study. PLoS One 2020; 15:e0229531. [PMID: 32102091 PMCID: PMC7043931 DOI: 10.1371/journal.pone.0229531] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background and objective Surgical complications after kidney transplantation can lead to catastrophic outcomes. Frailty has been associated with important kidney transplantation outcomes; however, there are no studies assessing this measure of physiological reserve as a specific predictor of surgical complications in this population. Such an assessment was, therefore, the objective of the present study. Methods A total of 87 individuals aged ≥ 18 years who underwent kidney transplantation between March 2017 and March 2018 were included. At the time of admission for kidney transplantation, demographic, clinical, and kidney transplantation data were collected, and the frailty score was calculated according to Fried et al., which comprises five components: shrinking, weakness, exhaustion, low activity, and slowed walking speed. Urological, vascular, and general surgical complications were assessed three months later, or until graft loss or death. The propensity score was used to achieve a better homogeneity of the sample, and new analyses were performed in this new, balanced sample. Results Of the 87 individuals included, 30 (34.5%) had surgical complications. After propensity score matching, the risk of surgical complications was significantly higher among the frail individuals (RR 2.14; 95% CI 1.01–4.54; p = 0.035); specifically, the risk of noninfectious surgical complications was significantly higher among these individuals (RR 2.50; 95% CI 1.11–5.62; p = 0.017). Conclusion The results showed that individuals with some degree of frailty before kidney transplantation were more subject to surgical complications. The calculation of the frailty score for transplant candidates and the implementations of measures to increase the physiological reserve of these patients at the time of kidney transplantation may possibly reduce the occurrence of surgical complications.
Collapse
|
7
|
Khandoga A, Thomas M, Kleespies A, Kühnke L, Andrassy J, Habicht A, Stangl M, Guba M, Angele M, Werner J, Rentsch M. Surgical complications and cardiovascular comorbidity – Substantial non-immunological confounders of survival after living donor kidney transplantation. Surgeon 2019; 17:63-72. [DOI: 10.1016/j.surge.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 11/28/2022]
|
8
|
Kulu Y, Fathi P, Golriz M, Khajeh E, Sabagh M, Ghamarnejad O, Mieth M, Ulrich A, Hackert T, Müller-Stich BP, Strobel O, Michalski C, Morath C, Zeier M, Büchler MW, Mehrabi A. Impact of Surgeon's Experience on Vascular and Haemorrhagic Complications After Kidney Transplantation. Eur J Vasc Endovasc Surg 2019; 57:139-149. [DOI: 10.1016/j.ejvs.2018.07.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 07/24/2018] [Indexed: 01/09/2023]
|