Background: Laparoscopic approaches have not been performed in living right donor hepatectomy (LDRH) because these are more technically demanding and are associated with increased donor morbidity. Instead, several studies have described LDRH using an upper midline incision (UMI) to reduce donor morbidity. Herein, we describe our experience with small UMI as a standard procedure for LDRH.
Methods: We retrospectively reviewed the outcomes of 444 LDRH at our institution from January 2010 to June 2019; 124 donors received LDRH using UMI (UMI group) and 320 donors underwent LDRH using a J-shaped incision (J-shaped group). This incision has been performed regardless of graft type, body mass index, graft weight, or vascular variations. Patient demographic characteristics, intraoperative parameters, laboratory data, and postoperative complications were compared between the 2 groups.
Results: The mean size of the UMIs was 12.4 cm (range, 11-16 cm) and the overall complication rates did not differ significantly between the 2 groups. Most postoperative outcomes were not different between the 2 groups, but the length of hospital stay and operation time in the UMI group were significantly lower than those in the J-shaped group. In multivariate logistic regression analyses, only large grafts (>900 g) and significant hepatic steatosis (≥15%) were significant risk factors for difficult operation but not related to type of incision.
Conclusion: LDRH could be safely performed with a small UMI and could be considered as standard practice during LDRH.
Copyright © 2021. Published by Elsevier Inc.