What Kind of Incision Should Be Made to Reduce the Risk of Incisional Hernia in Kidney Transplantation?

BACKGROUND The incidence of incisional hernia following renal transplantation is 1.1% to 3.8%. The risk factors are immunosuppressive medications, impaired tissue quality, neuromuscular trauma due to the operation, and denervation. The incidence has been decreasing based on the shift from hockey-stick incision method to inguinal oblique incision method. The aim of this study was to minimize the development of incisional hernias due to renal transplantation. MATERIAL AND METHODS Twenty-four patients who underwent renal transplantation in 2015-2017 were retrospectively examined. All transplantations were performed with oblique incisions of 10-15 cm in the right or left inguinal region using polydioxanone (No. 2) loop sutures and continuous technique. RESULTS The mean age of study patients was 43 years (range 24-67 years). The mean body mass index (BMI) was 29 kg/m² (range 25-38 kg/m²). Of these patients, one had diabetes mellitus, two had chronic pulmonary disease, six were obese, one had poliomyelitis sequelae, and seven had hypoalbuminemia. None of the patients had ascites; five patients had a history of surgery for peritoneal dialysis. At the end of the one-year follow-up period, none of the patients had developed an incisional hernia. CONCLUSIONS We conclude that using the smallest possible semilunar line incision in the inguinal region would aid in preventing post-transplantation incisional hernias.