Incisional Hernia Risk Reduction for Living Kidney Donors: Kidney Extraction Site Matters

作者：Rachana Punukollu, Sandra Arias, Stephanie Ohara, Nica Alexandru, Logan Briggs, Christopher P. Cosentino, Peter E. Frasco, Paul E. Andrews, Michelle Nguyen, Shennen A. Mao, Julie K. Heimbach, Caroline C. Jadlowiec · 发表于：Journal of the American College of Surgeons · 年份：2025 · DOI：10.1097/xcs.0000000000001356 · 被引用次数：3 · 研究领域：Minimally Invasive Surgical Techniques、Ureteral procedures and complications、Intestinal and Peritoneal Adhesions

BACKGROUND: Although most transplant centers preferentially offer minimally invasive approaches to donor nephrectomies, there remains less standardization specific to the kidney extraction site. This study aimed to evaluate incisional hernia occurrence in living kidney donors based on kidney extraction site location. STUDY DESIGN: This was a retrospective study of all donors who underwent minimally invasive living donor nephrectomies at the Mayo Clinic Arizona between 2011 and 2023 with a 2-year external validation cohort from Mayo Clinic Florida and Mayo Clinic Minnesota. The cohort was divided into 2 groups based on the kidney extraction site type: midline infraumbilical and Pfannenstiel. RESULTS: In the primary cohort, incisional hernia occurrence was observed in 1.2% of donors with an infraumbilical midline kidney extraction site compared with 0.1% with a Pfannenstiel extraction site (p = 0.04). Donors with an infraumbilical midline kidney extraction site were more likely to be men (50.8% vs 23.3%, p < 0.0001), have a higher BMI (mean 27.2 vs 26 kg/m 2 , p < 0.0001), and have current or former tobacco use (p = 0.002). There were no differences in incisional hernia occurrence when comparing minimally invasive surgical techniques (p = 0.52). In the external validation cohort, hernia occurrence was observed in 4.5% of donors with a midline incision compared with 0.0% with a Pfannenstiel incision (p = 0.09). Using combined data from the 3 sites, the use of a Pfannenstiel inci...