title: Clinical outcomes of and patient satisfaction with different incision methods for donor hepatectomy in living donor liver transplantation.
abstract: With the decrease in the average donor age and the increase in the proportion of female donors, both donor safety and cosmetic appearance are major concerns for some living donors in living donor liver transplantation (LDLT) because a large abdominal incision is needed that may influence the donor's quality of life. In all, 429 donors who underwent donor hepatectomy for LDLT from April 2010 to February 2013 were included in the study. Donors were divided into 3 groups based on the type of incision: conventional inverted L incision (n = 268; the C group), upper midline incision (n = 147; the M group), and transverse incision with laparoscopy (n = 14; the T group). Demographics, perioperative outcomes, postoperative complications for donors and recipients, and questionnaire-derived donor satisfaction with cosmetic appearance were compared. The mean age was lower (P < 0.001), the female ratio was higher (P < 0.001), and the body mass index (BMI) was lower (P = 0.017) in the M and T groups versus the C group. The operation time (P < 0.001) and the hospital stay duration (P = 0.010) were lowest in the M group. The postoperative complications did not differ by the type of incision and also did not show any significant effect in a multivariate analysis (P = 0.867). In the assessment of questionnaire-derived donor satisfaction matched by age (±5 years), sex, graft, height, weight, and BMI, a more satisfactory cosmetic result and more self-confidence were noted in the M and T groups versus the C group. In conclusion, the use of a minimal incision is technically feasible for some donor hepatectomy cases with a favorable safety profile. The patient satisfaction levels were greater with improved cosmetic outcomes in cases of minimal incision versus cases of conventional incision.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Suk-Won
authors.initials: SW
authors.lastname: Suh
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Jeong-Moo
authors.initials: JM
authors.lastname: Lee
authors.forename: YoungRok
authors.initials: Y
authors.lastname: Choi
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002921:Cicatrix / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D061646:Operative Time; D017060:Patient Satisfaction; D011788:Quality of Life; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult