title: Bilateral nephrectomy of huge polycystic kidneys associated with a rectus abdominis diastasis and umbilical hernia.
abstract: BACKGROUND
  Patients with end-stage renal failure due to huge autosomal dominant polycystic kidney disease usually have an umbilical hernia and rectus abdominis diastasis, which are very troublesome. Pretransplant bilateral nephrectomy techniques does not manage the umbilical hernia and rectus abdominis diastasis. We report our experience in performing bilateral nephrectomy and repairing the rectus abdominis diastasis and umbilical hernia through the one, small incision.
  
  
  METHODS
  Four patients aged 37 to 43 years with huge polycystic kidneys, an umbilical hernia, and a rectus abdominis diastasis underwent bilateral pretransplant nephrectomy through a midline supraumbilical incision including the umbilical hernia defect. The kidneys were removed through this incision. The incision was closed with the transposition of rectus abdominis muscle, pants-over-vest-style, to correct the diastasis and the umbilical hernia.
  
  
  RESULTS
  The average operative time was 160 minutes (range, 130-180); the average larger kidney size was 33 cm (range, 32-34 cm); no major complications occurred; one patient who had preoperative low hemoglobin required blood transfusion. Patients were discharged from the hospital on postoperative day 7 with an esthetically pleasing belly, no rectus abdominis diastasis, and no umbilical hernia. One to two months after bilateral nephrectomy, the patients received a live donor kidney with an uneventful outcome.
  
  
  CONCLUSIONS
  A midline supraumbilical incision is an excellent approach for bilateral nephrectomy of huge polycystic kidneys. In addition, an umbilical hernia and rectus abdominis diastasis may be successfully repaired through same incision with good cosmetic results.
authors.affiliation: Department of Urology, São Paulo University Medical School, São Paulo, SP, Brazil. mlucon@uol.com.br
authors.forename: Marcos
authors.initials: M
authors.lastname: Lucon
authors.forename: Luiz Estevam
authors.initials: LE
authors.lastname: Ianhez
authors.forename: Antonio Marmo
authors.initials: AM
authors.lastname: Lucon
authors.forename: Jose L
authors.initials: JL
authors.lastname: Chambô
authors.forename: Emil
authors.initials: E
authors.lastname: Sabbaga
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000328:Adult; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D008297:Male; D009392:Nephrectomy / Q000379:methods* / Q000592:standards; D016891:Polycystic Kidney, Autosomal Dominant / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care; D017568:Rectus Abdominis / Q000601:surgery*