title: Subcostal versus transcostal mini donor nephrectomy: is rib resection responsible for pain related donor morbidity.
abstract: OBJECTIVE
  Conventional donor nephrectomy is associated with significant postoperative morbidity. Whether this morbidity is associated with rib resection or a long incision is not clear. We designed a prospective randomized study of subcostal and transcostal mini incision donor nephrectomy and compared the results.
  
  
  METHODS
  We performed 82 donor nephrectomies in the study period of December 2000 to July 2001. Open donor nephrectomies were randomized to subcostal (25) or transcostal (24) mini incision techniques. Results were compared and analyzed using the independent t test.
  
  
  RESULTS
  The subcostal and transcostal groups were comparable in terms of patient age, body mass index, nephrectomy side, number of renal vessels and incision length (9.32 vs 9.72 cm). Patients in the subcostal group had a lesser postoperative analgesic requirement (304 +/- 49.8 vs 487 +/- 74.1 mg, p = 0.0001), shorter hospital stay (2.36 +/- 0.7 vs 3.71 +/- 0.81 days, p = 0.0001) and early convalescence (26.56 +/- 4.06 vs 37.46 +/- 6.05 days) compared with the transcostal group. Warm ischemia time and recipient outcome were similar in the groups.
  
  
  CONCLUSIONS
  Rib sparing, subcostal mini incision donor nephrectomy has significantly less morbidity and a shorter hospital stay compared with the rib resection transcostal technique.
authors.affiliation: Department of Urology and Renal Transplantation, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow (U.P.)-226014 India. aneesh@sgpgi.ac.in
authors.forename: Aneesh
authors.initials: A
authors.lastname: Srivastava
authors.forename: Dileep Mani
authors.initials: DM
authors.lastname: Tripathi
authors.forename: Wahid
authors.initials: W
authors.lastname: Zaman
authors.forename: Anant
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D012272:Ribs / Q000601:surgery*