Background: Kidney transplantation in sub-saharan Africa in at the rudimentary stages. Majority of patients with chronic kidney disease have no access to renal replacement therapy and hence die from the disease. Donor nephrectomy (DN) is an important aspect of kidney transplantation. It entails safe retrieval of a healthy renal allograft from a donor for this purpose. Over the last 2 decades, open DN has given way to minimal invasive techniques like laparoscopic and robotic DN. However, DN via a mini-incision has gained popularity in many parts of the world as a suitable alternative to LDN especially where there are lack of facilities or expertise for LDN or robotic DN. Mini-incision donor nephrectomy (MIDN) is a modification of the ODN with incisions of<12cm in length and has been found to offer an acceptable scar, duration of hospital stay, pain assessment and generally less mobidity than with the traditional ODN. This study aims to describe our experience with mini-flank incision DN among Nigerian patients.
Patients and Methods: A prospective review of all donor nephrectomy patients performed in a single Nigerian kidney transplantation centre over a 30-months duration was made. Information obtained from these patients were classified as pre-, intra- and post-operative. Data include socio-demographic characteristics, pre-operative preparation, details of intra-operative techniques like side of donor nephrectomy, length of incision, duration of surgery, intra-operative complications,1st warm ischemic time and post-operative findings eg post-operative pain, days on admission, analgesic requirements, duration of ileus, commencement of oral intake and and cosmetic outlook of the scar. These were entered into a proforma and analyzed using SPSS version 21.
Results: A total of 304 patients underwent ODN during the study period, of which 230 (75.6%) had MIDN. Mean duration of the surgery was 130±28 minutes MIDN was mostly performed on patients with BMI of <30kg/msq and these patients had better post-operative pain control. Oral intake and ambulation was commenced on 1st day post-op and the cosmetic outcome was acceptable in over 90% of kidney donors.
Conclusion: Mini-incision for Donor Nephrectomy through the flank approach is a suitable alternative to laparoscopic donor nephrectomy in the developing world were facilities and skills for laparoscopic or robotic nephrectomies are unavailable. It offers shorter operating time and 1st warm ischemic time with comparable morbidity rate.
Key words: Renal transplantation, Donor Nephrectomy, Mini incision, Nigeria