Clinical outcomes of and patient satisfaction with different incision methods for donor hepatectomy in living donor liver transplantation

Abstract

With the decrease in the average donor age and the increase in the proportion of female donors, both donor safety and cosmetic appearance are major concerns for some living donors in living donor liver transplantation (LDLT) because a large abdominal incision is needed that may influence the donor's quality of life. In all, 429 donors who underwent donor hepatectomy for LDLT from April 2010 to February 2013 were included in the study. Donors were divided into 3 groups based on the type of incision: conventional inverted L incision (n 5 268; the C group), upper midline incision (n 5 147; the M group), and transverse incision with laparoscopy (n 5 14; the T group). Demographics, perioperative outcomes, postoperative complications for donors and recipients, and questionnaire-derived donor satisfaction with cosmetic appearance were compared. The mean age was lower (P < 0.001), the female ratio was higher (P < 0.001), and the body mass index (BMI) was lower (P 5 0.017) in the M and T groups versus the C group. The operation time (P < 0.001) and the hospital stay duration (P 5 0.010) were lowest in the M group. The postoperative complications did not differ by the type of incision and also did not show any significant effect in a multivariate analysis (P 5 0.867). In the assessment of questionnaire-derived donor satisfaction matched by age (65 years), sex, graft, height, weight, and BMI, a more satisfactory cosmetic result and more selfconfidence were noted in the M and T groups versus the C group. In conclusion, the use of a minimal incision is technically feasible for some donor hepatectomy cases with a favorable safety profile. The patient satisfaction levels were greater with improved cosmetic outcomes in cases of minimal incision versus cases of conventional incision. Liver Transpl 21:72-78, 2015. V C 2014 AASLD.

Hybrid Procedure in Living Donor Liver Transplantation

“…In the donor procedure, after sufficient mobilization of the liver, sufficiently wide surgical fields are available through the upper hepatectomy (12). In that study, the satisfaction levels of the patients treated with an upper midline incision or transverse incision using laparoscopy were higher and had improved cosmetic outcomes compared to cases treated with a conventional incision (12).…”

Meta-Analysis of Laparoscopic versus Open Hepatectomy for Live Liver Donors

“…Twenty-five articles were reviewed in detail. Finally, 9 non-randomized comparative studies were included for the current meta-analysis[12, 13, 21–27]. …”

Outcomes of liver resection in patients with colorectal liver metastases by laparoscopic or open surgery

“…This is not special as an upper midline incision is generalized for liver resection. One study has compared a minimal incision and inverted L incision 13. All single OSLR procedures were performed with only an upper midline incision which was a minimal incision for a right hemihepatectomy during major liver resection.…”

“…Major liver resection is traditionally performed with an inverted L incision or an inverted T incision. One study has compared minimal open surgery with a previous large incision surgery13 and found that minimal open surgery is feasible for the surgeon and patient.…”