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P8.029 Mini-flank donor nephrectomy incision: a single centre experience from Nigeria

Martin C. Igbokwe, Nigeria

Consultant Urologist/ Kidney Transplant Surgeon
Urology Division
Zenith Medical and Kidney Centre

Biography


Dr Igbokwe Martin C.
 *MB.ChB, FWACS, FMCS (Urol)

Consultant Urologist/ Kidney transplant Surgeon
Practicing currently at Zenith Medical and Kidney Centre (ZMKC), Abuja.
He is a Fellow of the West African College of Surgeons and also a Fellow of the National Postgraduate Medical College of Nigeria.
He is an African Cancer Fellow .
Martin is the Head of Urology at ZMKC where he performs the most kidney transplant surgeries in Sub-saharan Africa with an average of 100 cases annually. The centre also has a robust haemodialysis unit with close to 50 dialysis machines and caters for the teeming population of Chronic Kidney Disease patients in Nigeria.
He is a member of the Transplant Association of Nigeria, Nigerian Association of Urological Surgeons, Nigerian Cancer Society and many international medical organisations .
An avid researcher with over 40 publications in peer-reviewed National and International Journals with interest in Kidney health/transplantation, Endo-urology, Uro-oncology and Andrology.
 

Abstract

Mini-flank donor nephrectomy incision: a single centre experience from Nigeria

Martin Igbokwe1, Olalekan Olatise2, Abayomi Aremu1, Sadiq Abu1, Uzodinma Onwuasoanya1, Fola Adetunbi1, Stephen Asaolu3, Michael Muoka3, Sani Alhassan4, Rashad Hazem5.

1Urological Surgery, Zenith Medical and Kidney Centre, Abuja, Nigeria; 2Nephrology Unit, Zenith Medical and Kidney Centre, Abuja, Nigeria; 3Statistics, Zenith Medical and Kidney Centre, Abuja, Nigeria; 4Urological Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria; 5Kidney transplantation and Urologic-Oncology Unit, Alexandria University Hospitals and faculty of Medicine, Alexandria, Egypt

Background: Kidney transplantation in sub-saharan Africa in at the rudimentary stages . Majority of patients with chronic kidney disease have no access to renal replacement therapy and hence die from the disease. Donor nephrectomy (DN) is an important aspect of  kidney transplantation. It entails safe retrieval of a healthy renal allograft from a donor for this purpose. Over the last 2 decades, open DN has given way to minimal invasive techniques like laparoscopic and robotic DN. However, DN via a mini-incision has gained popularity in many parts of the world as a suitable alternative to LDN especially where there are lack of facilities or expertise for LDN or robotic DN. Mini-incision donor nephrectomy (MIDN) is a modification of the ODN with incisions of<12cm in length and has been found to offer an acceptable scar, duration of hospital stay, pain assessment and generally less mobidity than with the traditional ODN. This study aims to describe our experience with mini-flank incision DN among Nigerian patients.

Patients and Methods: A prospective review of all donor nephrectomy patients performed in a single Nigerian kidney transplantation centre over a 30-months duration was made. Information obtained from these patients were classified as pre-, intra- and post-operative. Data include socio-demographic characteristics, pre-operative preparation, details of intra-operative techniques like side of donor nephrectomy, length of incision, duration of surgery, intra-operative complications,1st  warm ischemic time and post-operative findings eg  post-operative pain, days on admission, analgesic requirements, duration of ileus, commencement of oral intake and and cosmetic outlook  of the scar. These were entered into a proforma and analyzed using SPSS version 21.

Results:  A total of 304 patients underwent ODN during the study period, of which 230 (75.6%) had MIDN. Mean duration of  the surgery was 130±28 minutes .MIDN  was mostly performed on patients with BMI of <30kg/msq  and these patients had better post-operative pain control. Oral intake and ambulation was commenced on 1st day post-op and the cosmetic outcome was acceptable in over 90% of kidney donors.

Conclusion: Mini-incision for Donor Nephrectomy through the flank approach is a suitable alternative to laparoscopic donor nephrectomy in the developing world were facilities and skills for laparoscopic or robotic nephrectomies are unavailable. It offers shorter operating time and 1st warm ischemic time with comparable morbidity rate.

Key words:  Renal transplantation, Donor Nephrectomy, Mini incision, Nigeria

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