Incisional Hernia Post Hand Assisted Laparoscopic Donor Nephrectomy: Significant donor morbidity
Adnan Taib1, Zia Moinuddin1,2, Alex Shaw1,2, Martyn Stott1, Babatunde Campbell1, Titus Augustine1,2, David van Dellen1,2
1Department of Renal & Pancreas Transplantation, Manchester University NHS Foundation Trust, Manchester, UK
2 Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
Introduction:
Hand Assisted Laparoscopic Donor Nephrectomy (HALDN) has evolved to allow safe minimally-invasive kidney donation, via a hand port incision, whilst ensuring the post-operative benefits of laparoscopic surgery. Morbidity in this group of patients is undesirable. However, the reported incidence of significant long-term surgical complications in this cohort, including incisional hernia (IH), remains variable. This study aimed to investigate the incidence and potential risk factors in the IH development post HALDN.
Methods:
A retrospective analysis of a contemporaneously maintained database and electronic records of patients who underwent intraperitoneal HALDN at a single centre over 10 years (01/2008-11/2018) was performed. Data collected included incidence and time to diagnosis of incisional hernia. Potential patient confounders (demographics, BMI, smoking status, respiratory co-morbidities, previous abdominopelvic surgery, hernia history) and surgical risk factors (hand port site, wound complications, re-operation, post-operative chest infection) were also assessed. Univariate and multivariate logistic regression analysis was performed.
Results: 
There was an IH incidence of 8.9% (n=69) in 771 patients following intraperitoneal HALDN. Median time to hernia diagnosis was 12 months (IQR 5-16). Univariate analysis revealed respiratory co-morbidities (14.5% vs 6%, p=0.019), obesity (BMI≥ 30kg/m2) (35.5% vs 19.7%, p=0.017), wound complications (24.6% vs 9%, p=0.01), re-operation (7.2% vs 2.1%, p=0.027), post-operative chest infection (23.2% vs 10%, p=0.02) as risk factors for incisional hernia occurrence. On multivariate analysis respiratory co-morbidities (OR 2.96, 95% CI 1.21 – 7.24), re-operation (OR 3.64, 95% CI 1.04-12.69) and post-operative chest infection (OR 2.46, 95% CI 1.21 – 5.02) were significant predictive factors for hernia formation. 
Discussion:
Incisional hernia post HALDN is a major complication with significant morbidity in a previously healthy population. Pre- and post-operative respiratory compromise and re-operation appears to increase risk. Focused prehabilitation and post-operative care (enhanced recovery) may therefore mitigate IH risk. Further studies comparing incisional hernias in total laparoscopic and laparoscopic assisted techniques are also needed to establish if technique refinement may be of benefit.

[MP33] Incisional Hernia Post Hand Assisted Laparoscopic Donor Nephrectomy: Significant donor morbidity