Prospective randomized trial of abdominal versus lumbar extraction incisions after retroperitoneal laparoscopic left nephrectomy in living donors.

BACKGROUND

The optimal specimen extraction site after retroperitoneal laparoscopic donor nephrectomy is debated. This study compared abdominal versus lumbar incisions on hernia risk, motor function, and quality of life.

METHODS

This prospective, single-blind RCT, 240 living kidney donors were randomized 1:1 to an abdominal diagonal or a lumbar horizontal extraction incision. Primary outcomes were incisional hernia incidence at 12 months (verified by ultrasound) and abdominal wall motor function deficits at 6 months (measured by dynamometry and surface electromyography). Secondary outcomes included sensory disturbances, pain, analgesic requirements, and SF-36 scores.

RESULTS

Of 240 randomized donors, 234 completed 12-month follow-up (117 abdominal, 117 lumbar group). Incisional hernia occurred in 3 patients (2.6%) in the abdominal group versus 9 patients (7.7%) in the lumbar group (relative risk 0.33, 95% CI 0.09-1.19, p = 0.086, non-significant). Motor function deficits were significantly lower in the abdominal group (mean difference - 12.4 N·m, 95% CI -18.6 to -6.2, p < 0.001). Visual analog scale pain scores at 24 h were 3.2 ± 1.4 in the abdominal versus 4.8 ± 1.6 in the lumbar group (p < 0.001). Total morphine equivalent consumption within 72 h was 32.5 ± 12.3 mg versus 48.6 ± 15.7 mg respectively (p < 0.001). SF-36 physical functioning scores at 12 months were significantly higher in the abdominal group (88.4 ± 9.2 vs. 82.1 ± 11.3, p < 0.001).

CONCLUSION

Abdominal extraction incisions demonstrated potentially advantageous outcomes including lower incisional hernia rates, reduced motor function deficits, decreased postoperative pain, and improved long-term quality of life compared to lumbar incisions.