THE IMPACT OF MIDLINE VERSUS TRANSVERSE INCISIONS ON WOUND COMPLICATIONS AND OUTCOME IN SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTS - A RETROSPECTIVE ANALYSIS

Intraperitoneal place ment of the pancreas allograft, usually through a midline incision? has so far achieved the best results in pancreas t ransplantation. The usefulness and safety of a transverse incision has not been previously reported. The purpose of this study was to compar e midline and transverse incisions, with respect to wound complication s and outcome, in simultaneous pancreas-kidney transplant recipients w ith intraperitoneal placement of the pancreatic graft. The incidence o f deep abscess formation, superficial abscess formation, wound leak, a nd fascial dehiscence, as well as graft survival, were retrospectively compared in 41 bladder-drained simultaneous pancreas-kidney recipient s with a midline incision and in 15 with a transverse incision. The ov erall incidence of wound complications was similar (34% vs 20%, P = NS ) in the two groups. Deep abscess formation occurred more frequently i n the midline group (27% vs 0%, P = 0.02). Staphylococcus epidermidis and Candida albicans were the most common microbial isolates from deep abscesses. Multivariate logistic regression analysis revealed donor a ge 40 years or older (P = 0.04), the occurrence of a bladder leak (P = 0.05), and a peak serum amylase in the Ist week of 1000 IU/l or great er (P = 0.02) to be independent risk factors far the development of wo und complications. The type of incision, however was not found to be a n independent risk factor. Patient (90% vs 83%, P = NS), pancreas allo graft (78% vs 82%, P = NS), and kidney allograft (83% vs 70%. P = NS) survival rates were similar for the midline and transverse groups. We conclude that the transverse incision is a reasonable alternative to t he midline incision in simultaneous pancreas-kidney transplantation an d it is presently the incision of choice at our institution. It offers excellent exposure and is associated with a similar wound complicatio n rate and outcome when compared to the midline incision.