Usage of Modified Makuuchi Incision for Surgical Management of Complex Renal and Adrenal Lesions

Bokka, Sri Harsha; Kodakkattil, Sreerag Sreenivasan; Manikandan, Ramanitharan; Narayanan, Dorairajan Lalgudi; Munuswamy, Hemachandren; Kalra, Sanjay; Pottakkat, Biju

doi:10.7759/cureus.11012

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…However, for large kidney tumors or surgeries in need of the manipulation of other organs such as the liver, pancreas, and spleen, other approaches may be required. 3 There have been some advantages described in the literature for MMI. In their study of 144 cases, Pandit et al showed that the MMI provided many operative ergonomics and less postoperative pain according to thoracoabdominal and inverted T incision.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Modified Makuuchi Incision in Terms of Postoperative Pain, Incisional Hernia, and Cosmetics: Observational Study

OLGUN¹,

ATAN²,

Polat³

et al. 2023

J Reconstr Urol

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The modified Makuuchi incision (MMI) consists of a midline incision from the xiphoid to just above the umbilicus, and a transverse incision to the 12th rib. It is J-shaped on the right and L-shaped on the left side. We aimed to evaluate the postoperative pain, incisional hernia, and cosmetic satisfaction of patients who underwent renal surgery with this technique. Material and Methods: Between January 1, 2015 and March 31, 2021, patients who performed simple, partial, and radical nephrectomy with MMI in our clinic were determined, and whose surgery was performed at least 3 months ago and had contact information in hospital records were called by phone. They were questioned in terms of incisional pain, incisional bulging or hernia, and cosmetic appearance. Results: A total of 152 patients with kidney surgery were identified. Ninety-seven were operated via MMI, and 57 of them were interviewed. Thirty-seven were male and 20 were female. The mean age was 55.3 years (21-86 years) and the mean postoperative follow-up period was 28 months (3-75 months). There was no patient with ongoing pain and was still in need of analgesics. Fortyfive patients (78.9%) stated that they were satisfied with the cosmetic appearance. One patient (1.7%) reported incisional bulging and 1 (1.7%) reported a hernia. Conclusion: In cases with large renal tumors or a history of previous abdominal surgery, MMI did not cause permanent and serious problems in terms of pain, cosmetic, and herniation. We think that it is useful to know this incision for urologists who are interted in complicated renal surgeries.

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Section: Discussionmentioning

confidence: 99%

“…As well, its use in adrenal and renal surgery is increasing. 3,4 This study aimed to evaluate the postoperative pain, incisional hernia, and cosmetic satisfaction of patients who underwent renal surgery with this technique.…”

Section: Anah Tar Ke LI Me Ler: Böbrek Cerrahisi; Makuuchi; Ağrı; Her...mentioning

confidence: 99%

Evaluation of Modified Makuuchi Incision in Terms of Postoperative Pain, Incisional Hernia, and Cosmetics: Observational Study

OLGUN¹,

ATAN²,

Polat³

et al. 2023

J Reconstr Urol

View full text Add to dashboard Cite

show abstract

“…Patients receiving conventional open hepato-biliary surgeries, among others, were particularly vulnerable to wound pain since they usually present with multiple comorbidities and are left with a large incision [ 8 ]. The most frequently used surgical incision for open liver resection is modified Makuuchi incision, which commences from xiphoid to about one to two centimeters above the umbilicus, and then extends laterally to the right [ 9 , 10 , 11 , 12 ]. According to the ERAS society, there is clinical equipoise in postoperative pain control for open liver surgery [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Comparison of Three Patient-Controlled Analgesic Strategies: Intravenous Opioid Analgesia Plus Abdominal Wall Nerve Blocks versus Epidural Analgesia versus Intravenous Opioid Analgesia Alone in Open Liver Surgery

Tsai

Zheng

et al. 2022

Biomedicines

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Background: Adequate pain control is of crucial importance to patient recovery and satisfaction following abdominal surgeries. The optimal analgesia regimen remains controversial in liver resections. Methods: Three groups of patients undergoing open hepatectomies were retrospectively analyzed, reviewing intravenous patient-controlled analgesia (IV-PCA) versus IV-PCA in addition to bilateral rectus sheath and subcostal transversus abdominis plane nerve blocks (IV-PCA + NBs) versus patient-controlled thoracic epidural analgesia (TEA). Patient-reported pain scores and clinical data were extracted and correlated with the method of analgesia. Outcomes included total morphine consumption and numerical rating scale (NRS) at rest and on movement over the first three postoperative days, time to remove the nasogastric tube and urinary catheter, time to commence on fluid and soft diet, and length of hospital stay. Results: The TEA group required less morphine over the first three postoperative days than IV-PCA and IV-PCA + NBs groups (9.21 ± 4.91 mg, 83.53 ± 49.51 mg, and 64.17 ± 31.96 mg, respectively, p < 0.001). Even though no statistical difference was demonstrated in NRS scores on the first three postoperative days at rest and on movement, the IV-PCA group showed delayed removal of urinary catheter (removal on postoperative day 4.93 ± 5.08, 3.87 ± 1.31, and 3.70 ± 1.30, respectively) and prolonged length of hospital stay (discharged on postoperative day 12.71 ± 7.26, 11.79 ± 5.71, and 10.02 ± 4.52, respectively) as compared to IV-PCA + NBs and TEA groups. Conclusions: For postoperative pain management, it is expected that the TEA group required the least amount of opioid; however, IV-PCA + NBs and TEA demonstrated comparable postoperative outcomes, namely, the time to remove nasogastric tube/urinary catheter, to start the diet, and the length of hospital stay. IV-PCA with NBs could thus be a reliable analgesic modality for patients undergoing open liver resections.

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Update on Management of Pediatric Renal Neoplasms

Peard,

Passoni,

Walker

et al. 2023

Curr Treat Options Peds

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Usage of Modified Makuuchi Incision for Surgical Management of Complex Renal and Adrenal Lesions

Abstract: Bokka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 4 publications

References 12 publications

Evaluation of Modified Makuuchi Incision in Terms of Postoperative Pain, Incisional Hernia, and Cosmetics: Observational Study

Evaluation of Modified Makuuchi Incision in Terms of Postoperative Pain, Incisional Hernia, and Cosmetics: Observational Study

A Retrospective Comparison of Three Patient-Controlled Analgesic Strategies: Intravenous Opioid Analgesia Plus Abdominal Wall Nerve Blocks versus Epidural Analgesia versus Intravenous Opioid Analgesia Alone in Open Liver Surgery

Update on Management of Pediatric Renal Neoplasms

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