Laparoscopic kidney donation: The impact of adhesions.
BACKGROUND
Adhesion formation following abdominal surgery causes substantial burden to society. Laparoscopic donor nephrectomy (LDN) offers an opportunity to study the prevalence of adhesions in healthy individuals. Furthermore we evaluated whether or not adhesions hindered LDN.


METHODS
Data of 161 LDNs were prospectively collected. The presence of adhesions was documented. Parameters influenced by the presence of adhesions such as operation time, blood loss, and intraoperative complications were documented.


RESULTS
Twenty-eight of 44 donors (64%) who had had prior abdominal surgery presented with adhesions at laparoscopy versus 61 of 107 donors (52%) who had no history of abdominal surgery (P = 0.22). Conversion and complication rate, operation times, and blood loss did not differ between those with and without a previous history of abdominal surgery. Blood loss and operation time did not differ between donors with and without adhesions. The number of conversions to open was significantly higher in donors with adhesions (9 versus 0, P = 0.005). Three conversions were due to adhesions.


CONCLUSIONS
Adhesions are present in a significant number of healthy individuals regardless of a history of previous abdominal operations. As these operations are of no predictive value for the number and complexity of adhesion formation, we advocate starting live kidney donation laparoscopically as the procedure can be most probably conducted successfully by this approach.
Kok
Niels F M
NF
Department of Surgery, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. n.f.m.kok@erasmusmc.nl
van der Wal
J B C
JB
Alwayn
Ian P J
IP
Tran
Khe T C
KT
IJzermans
Jan N M
JN
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D016030:Kidney Transplantation / Q000379:methods / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D000267:Tissue Adhesions / Q000453:epidemiology*; D020858:Tissue and Organ Harvesting / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult