Bilateral Nephrectomy of Huge Polycystic Kidneys Associated With a Rectus Abdominis Diastasis and Umbilical Hernia

Abstract

Lucon M, Ianhez LE , Lucon AM, Chambô JL, Sabbaga E, Srougi M. Bilateral nephrectomy of huge polycystic kidneys associated with a rectus abdominis diastasis and umbilical hérnia. Clinics. 2006;61(6):529-34. BACKGROUND:Patients with end-stage renal failure due to huge autosomal dominant polycystic kidney disease usually have an umbilical hernia and rectus abdominis diastasis, which are very troublesome. Pretransplant bilateral nephrectomy techniques does not manage the umbilical hernia and rectus abdominis diastasis. We report our experience in performing bilateral nephrectomy and repairing the rectus abdominis diastasis and umbilical hernia through the one, small incision. METHODS: Four patients aged 37 to 43 years with huge polycystic kidneys, an umbilical hernia, and a rectus abdominis diastasis underwent bilateral pretransplant nephrectomy through a midline supraumbilical incision including the umbilical hernia defect. The kidneys were removed through this incision. The incision was closed with the transposition of rectus abdominis muscle, pants-over-vest-style, to correct the diastasis and the umbilical hernia. RESULTS: The average operative time was 160 minutes (range, 130-180); the average larger kidney size was 33 cm (range, 32-34 cm

Treatment Options for Abdominal Rectus Diastasis

“…The most widely used open approach is a classic abdominoplasty with transverse suprapubic incision extended laterally to the anterior iliac crests to visualize the rectus muscles and the linea alba (7, 12, 15–19). Other incisions are possible as well: midline supraumbilical incision, typically used in cases of other coexisting conditions (nephrectomy and hernia) (20, 21); left suprapubic incision, extended 2–3 cm upwards; and midline ventral incision, extending from the xiphiod process to the pubic area (22, 23).…”