Acute and chronic postsurgical pain after living liver donation: Incidence and predictors

Abstract

TO THE EDITOR:We are very interested in the work of Holtzman et al. 1 The authors of that study addressed the fact that persistent postsurgical pain was reported by 31% of the donors at the 6-month follow-up and by 27% of the donors at the 12-month follow-up. In addition to the evaluation of pain, we would like to address the importance of also taking care of other surgical scar-related complaints. Jain et al. 2 reported the incidence of numbness of the abdominal skin between the subcostal incision and the umbilicus in recipients after liver transplantation. Surprisingly, 100% of the recipients included in the study by Jain et al. 2 (n 5 101) had persistent numbness even up to 9 years after surgery. Hence, abdominal wall numbness should be taken into account for living donors who have undergone a subcostal incision.Recently, there have been several attempts to reduce surgical scar-related complications by adopting different types of incisions other than a subcostal incision. [3][4][5] Because donor safety is the highest priority in living donor liver transplantation, once the safety of these new procedures has been proven, evaluating surgical scarrelated symptoms or complications following the use of different types of incisions should be considered. 5 We have conducted a cross-sectional study using a self-assessment questionnaire to survey the actual status of surgical scar-related complications (n 5 87). 6 Forty-two percent of the donors with a Mercedes-Benz (MB)-type incision with a median follow-up of 86 months (range, 35-168 months) complained of persistent pain; the longest follow-up period of a donor with persistent pain was 168 months. The rate of numbness was 30% in donors with the MB incision and was 29% in donors with subcostal incisions with a median follow-up of 21 months (range, 7-46 months), in contrast to a 10% occurrence of numbness in donors with an upper-midline incision, even though the follow-up period was relatively shorter in that group (median, 10.5 months; range, 13-26 months). Furthermore, a partial loss of cutaneous sensation was also observed in 47% of the MB incision group, 39% of the subcostal incision group, and 22% of the upper-midline incision group.We fully agree with Holtzman et al., 1 who concluded that understanding and improving pain outcomes has been identified as a key priority by liver transplant clinicians. 1 Liver transplant clinicians should meticulously follow up with living liver donors with respect to the surgical scar, paying attention not only to pain but also to several other types of possible complications, such as numbness, tactile abnormalities, and so on.

Standardized hybrid living donor hemihepatectomy in adult‐to‐adult living donor liver transplantation

“…In addition, the hybrid LD hepatectomy described in this study can cope with accidental bleeding in laparotomy, and it is considered to be a rational and useful method that balances safety and tolerability with patient satisfaction as we reported earlier. (16,17) In order to generalize minimally invasive surgical procedures, we believe that recovery shots during intraoperative accidents can be performed as in conventional laparotomy. (18,19) Especially at the time of donor surgery for LDLT, the timing for recovery shots should not be delayed.…”

A comparison of postoperative pain between transumbilical and suprapubic incision in laparoscopic liver resection

“…6 The donors who underwent hepatectomy with an upper midline incision showed less numbness of the abdominal wall compared to the donors with Mercedes-Benz incision or right subcostal incisions up to xiphoid incisions. [7][8][9] In terms of appearance, sensation, and daily activities, living donor hepatectomy with an upper midline incision was found to have a good self-assessment compared with that performed using other types of incisions. Most recently, Watanabe et al investigated the impact of the abdominal incision type on postoperative pain by a visual analog scale (VAS) at several timepoints until postoperative day 90 in patients following hepatectomy with an open approach, hybrid approach, and pure laparoscopic approach.…”

“…We previously reported the subjective evaluation of postoperative wound‐related symptoms in living liver donors depending on the type of incision made, based on the results of an original questionnaire concerning not only the short‐term symptoms, such as pain, but also long‐term symptoms, such as numbness 6 . The donors who underwent hepatectomy with an upper midline incision showed less numbness of the abdominal wall compared to the donors with Mercedes‐Benz incision or right subcostal incisions up to xiphoid incisions 7–9 . In terms of appearance, sensation, and daily activities, living donor hepatectomy with an upper midline incision was found to have a good self‐assessment compared with that performed using other types of incisions.…”

Gonadal hormone–dependent nociceptor sensitization maintains nociplastic pain state in female mice

“…Nociplastic pain is female-predominant chronic pain 27,35,38 arising from altered nociception in the absence of tissue damage or overt somatosensory neuropathy directly driving the pain. 20 Although the incidence of these conditions skews toward women, clinical studies on whether female gonadal hormones mediate the development of nociplastic pain are equivocal.…”