title: Extraperitoneal access for kidney transplantation in children weighing 20 kg. or less.
abstract: OBJECTIVE
  We present our experience with kidney transplantation in children weighing 20 kg. or less. Surgery was done via extraperitoneal access while preserving the peritoneal cavity intact with special attention given to technical feasibility and the complication rate.
  
  
  METHODS
  Included in our study were 46 children with a median age of 7 years weighing 20 kg. or less (mean 16.6), of whom 16 weighed less than 15 kg. (median 13.2). The 25 boys and 21 girls underwent a total of 49 kidney transplants, including 2 in 3 during the study. Donors were living related in 44 cases and cadaveric in 5. Surgical access was obtained by making a J-shaped pararectal incision in a curvilinear fashion from the symphysis pubis to near the costal border.
  
  
  RESULTS
  Mean hospital stay was 22.9 days (range 6 to 83) and mean followup was 55.8 months (range 12 to 131). All patients received water on day 1 and food on day 2 postoperatively. In 6 patients 7 surgical complications developed, including urinary fistula in 2, superficial wound infection in 2 and vascular complications in 3 (renal vein thrombosis, stenosis and renal artery kinking in 1 each). Only 1 graft was lost due to a surgical complication.
  
  
  CONCLUSIONS
  There are many advantages to using extraperitoneal access without an increase in surgical complications or technical difficulty. Absent gastrointestinal complications, an easier way to perform percutaneous biopsy, treatment of any surgical complication with no need for repeat laparotomy and the possibility of using the peritoneal cavity when dialysis is needed postoperatively are attractive justifications for extraperitoneal access.
authors.affiliation: Unidade de Transplantes Renais do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: W C
authors.initials: WC
authors.lastname: Nahas
authors.forename: E
authors.initials: E
authors.lastname: Mazzucchi
authors.forename: A G
authors.initials: AG
authors.lastname: Scafuri
authors.forename: I
authors.initials: I
authors.lastname: Antonopoulos
authors.forename: E D
authors.initials: ED
authors.lastname: Neto
authors.forename: L E
authors.initials: LE
authors.lastname: Ianhez
authors.forename: S
authors.initials: S
authors.lastname: Arap
mesh_terms: D001835:Body Weight; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D010529:Peritoneal Cavity; D011183:Postoperative Complications