Transumbilical laparoendoscopic single-site donor nephrectomy: evolving trends.

BACKGROUND: We report our experience with laparoendoscopic single-site donor nephrectomy (LESS DN). METHODS: Retrospective comparative study of data from 200 Consecutive left LESS DN (group A) compared to 205 consecutive conventional laparoscopic donor nephrectomy (LDN) (group B). Standard laparoscopic instruments were used in all patients. Right nephrectomies were excluded. RESULTS: From 05/2015 to 12/2017, 200 LESS DN (group A) and from 10/2011 till 04/2015, 205 LDN (group B) were performed. In group A and B, respectively, the mean operative time was 175.9 ± 24.9 versus 199.88 ± 37.06 min (p = 0.0001), the mean warm ischemia time was 5.2 ± 1.02 versus 3.64 ± 1.38 min (p = 0.0001), the mean BMI was 24.8 ± 4.5 versus 25.2 ± 4.7 kg/m2, complex vascular anatomy was found in 60 (30%) and 68 (33.2%), average length of incision was 5.2 versus 7.7 cm (p = 0.001), scar satisfaction rate 8 versus 6 (p = 0.004), mean morphine equivalents 81.0 versus 70.5 mg; (p = 0.03), average timing for return to work was 42 versus 50 days; (p = 0.001). There was no conversion to open surgery in both groups. One case converted to hand-assisted laparoscopic nephrectomy in group A. Pure LESS-DN was successfully completed in 169 patients (84.5%). In group A, due to technical difficulties, additional 1 or 2, 5-mm port(s) was added in 21 and 10 cases, respectively. Two negative explorations were performed in the first post-operative week for picture of small bowel obstruction. We had port site hernia in one donor, superficial wound infection in three donors and blood transfusion was required in two donors in group A. CONCLUSIONS: Our experience with LESS-DN is encouraging. LESSDN can be integrated as a standard approach for renal donation without additional donor risk. Moreover, LESS DN gives more flexibility by possibility to add one or more 5-mm ports in case of technical difficulties.

A single-center 4-year experience with 47 pediatric renal transplants: Evolving trends.

Outcome of pediatric kidney transplantation (KT) has improved over the last several decades. We retrospectively reviewed the outcomes pediatric KT in King Faisal Specialist Hospital and Research Center-Jeddah, Saudi Arabia. Between May 2013 and November 2016, we performed renal transplantation in 47 children, 30 (64%) males, and 17 (36%) females. All patients received antibody induction with basiliximab or antithymocyte globulin along with triple immunosuppressive therapy with tacrolimus, mycophenolate mofetil and steroids. Twenty-four (51%) and 14 (30%) patients were on hemodialysis and peritoneal dialysis, respectively. Average duration on dialysis was 18.3 months. Nine patients (19%) had preemptive transplant. Forty-five patients (95.7%) received kidneys from living donors, 38 (83%) males and nine (17%) females, mean age (years), and body mass index were 30.8 ± 8.82 and 23.8 ± 4.54, respectively. Forty-one donors had left nephrectomy. Four right nephrectomies were reported, all of them were through open nephrectomy. Open nephrectomy was reported in 21 (46%) patients. Several laparoscopic nephrectomy techniques were performed; conventional laparoscopic donor nephrectomy, laparo-endoscopic single-site donor nephrectomy, and hand-assisted laparoscopic surgery in 10, 11, and three patients, respectively. The most common etiologies of end-stage renal disease were focal segmental glomerulosclerosis 19%, posterior urethral valve 8.5%, and congenital abnormalities 8.5% respectively. With a mean follow-up of 54 months, one and 4-year graft survival rates were 95.7% and 91.5%, respectively. One-and four-year patient survival rates were 100%. Outcomes were similar in patients < or ≥10 years. The graft survival was comparable in laparoscopic versus open donor nephrectomy (P = 0.72). Average serum creatinine was 0.85, 0.79, 0.79, and 0.84 at 7, 30, 90, 365 days, respectively. Four patients lost their graft due to renal vein thrombosis, chronic allograft nephropathy (cadaveric donor), Antibody-mediated rejection, and hemolytic-uremic syndrome at 0.75, 9, 19, and 24 months, respectively. The incidences of acute rejection and major infection were 2% and 4%, respectively. One patient developed posttransplant lympho-proliferative disease that was treated and is still with excellent graft function. Our pediatric KT experience is encouraging. Acute rejection, patient, and graft survival rates are similar and even better than many of western reports.

Mini-laparoscopic cholecystectomy in children under 10 years of age with sickle cell disease.

BACKGROUND: Cholelithiasis is very common in patients with sickle cell disease (SCD) and is responsible for recurrent attacks of abdominal pain. The ideal management, especially for children, remains controversial. The purpose of the present study was to evaluate the safety and outcome of mini-laparoscopic cholecystectomy (MLC) in young children under age of 10 years with SCD. METHODS: A prospective study was carried out of 75 children with SCD under 10 years of age with recurrent abdominal pains seen between August 2001 and March 2004 at Armed Forces Hospital, Khamis Mushayt, Saudi Arabia, who were screened for cholelithiasis. Twelve (16%) of the 75 children were found to have gallstones. The mean age was 7.8 years (range 4-9 years). All 12 children underwent MLC. Anaemia was corrected preoperatively in all the patients. Operative time, intraoperative complications, hospital stay, and postoperative recurrent abdominal pain were recorded. RESULTS: The mean operating time was 46.5 min (range: 35-65 min). Intraoperative cholangiogram failed in two children due to narrow cystic ducts. The mean hospital stay was 2.1 days (range: 2-4 days). No patient required intra-abdominal drain. The mean follow-up period was 13.4 months (range: 4-24 months). The only postoperative complication was deep jaundice 1 month postoperatively due to cholestasis, and this responded to medical treatment. None of the children had recurrent abdominal pain after MLC. CONCLUSION: Mini-laparoscopic cholecystectomy is a safe surgical procedure for the management of cholelithiasis in children with SCD and leads to improvement in the quality of life by decreasing the frequency of recurrent abdominal pain.

Appraisal of the modified Alvarado Score for acute appendicits in adults.

OBJECTIVE: Decision making in cases of acute appendicitis may be difficult specially for junior surgeons. Radiological investigations do not appear to be helpful. In some studies, the Modified Alvarado Scoring System (MASS) was helpful in minimizing unnecessary appendicectomies. The aim this study was to evaluate the sensitivity of MASS in the diagnosis of acute appendicitis in adults. METHODS: All adult patients aged 16-years and above who were admitted with a provisional diagnosis of acute appendicitis between January 2001 and January 2002, into the Armed Forces Hospitals, Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia were prospectively entered into this study. The study included 125 patients between the ages of 16 and 76-years. They were prospectively evaluated on admission using the Modified Alvarado Score (MAS) to determine whether or not they had acute appendicitis. The MASS was correlated with the operative and histopathological findings. RESULTS: One hundred and 10 patients (88%) had appendicectomies of which 30 patients (27.3%) had normal appendices on histopathology examination. Overall the MAS system showed a sensitivity of 53.8% and a specificity of 80%. For males, the sensitivity was 56.4% and the specificity was 100%. For females, the sensitivity and specificity were 48% and 62.5%. CONCLUSION: From the results, the MASS is not sufficiently sensitive adopted as a method of diagnosing of acute appendicitis in adults in our environment. Further, requirements may be needed to improve its sensitivity and specificity.

A two-port laparoscopic placement of peritoneal dialysis catheter: a preliminary report.

Continuous ambulatory peritoneal dialysis (CAPD) is a well established modality for treating patients with end-stage renal disease (ESRD). The placement of a peritoneal dialysis catheter (PDC) is carried out either by the open method or by laparoscopy. The laparoscopic technique offers the major advantage of direct vision aiding placement of the catheter in the proper place and the additional performance of diagnostic laparoscopy. The traditional laparoscopic placement of PDC requires three ports. In this study, a two port technique for laparoscopic placement of PDC is described in nine patients. This prospective study was carried out at The Armed Forces Hospital, Khamis Mushayt, Saudi Arabia. Nine patients with ESRD underwent laparoscopic placement of the PDC between January 2001 and May 2002. There were seven females and two males, with a mean age of 52 years (range 38-75 years). The mean operating time was 41 minutes (range 30 -75 min). The mean post-operative hospital stay was 4.5 days (range 2-15 days). Two patients (22.2%) developed leakage of dialysate from the 5 mm-port and one patient (11.1%) had migration of the PDC. Our study suggests that this new modified technique appears to be safe and simple and is associated with rapid post-operative recovery.