COMBINED KIDNEY AND PANCREAS TRANSPLANTS THROUGH LOWER TRANSVERSE ABDOMINAL INCISIONS

Improvements in the surgical aspects of combined kidney and pancreas t ransplants have resulted in better overall graft and patient survival. Pancreas transplants were initially performed through lower transplan t flank incisions opposite the kidney. However, because of high wound complication rate, most centers now perform pancreas transplants throu gh lower midline incisions, We retrospectively reviewed our experience in 40 combined kidney and pancreas transplant recipients with an init ial group of 6 midline incisions and 34 later lower transverse abdomin al incisions. The number of midline incisions was too small to make a direct comparison, but our series of patients with transverse incision s was compared with the reported literature using a midline incision. The overall infectious and hernia rates for the transverse in cision w ere 12% and 6% respectively which are both very acceptable. The averag e operative time was 5.5 h, The transverse incision may be associated with less pain, shorter ileus, and fewer pulmonary complications, A lo wer transverse incision has the major advantage of excellent exposure directly over the iliac vessels and is our incision of choice.