The impact of midline versus transverse incisions on wound complications and outcome in simultaneous pancreas-kidney transplants: A retrospective analysis

Intraperitoneal placement of the pancreas allograft, usually through a midline incision, has so far achieved the best results in pancreas transplantation. The usefulness and safety of a transverse incision has not been previously reported. The purpose of this study was to compare midline and transverse incisions, with respect to wound complications and outcome, in simultaneous pancreas-kidney transplant recipients with intraperitoneal placement of the pancreatic graft. The incidence of deep abscess formation, superficial abscess formation, wound leak, and fascial dehiscence, as well as graft survival, were retrospectively compared in 41 bladder-drained simultaneous pancreas-kidney recipients with a midline incision and in 15 with a transverse incision. The overall incidence of wound complications was similar (34 % vs 20 %, P = NS) in the two groups. Deep abscess formation occurred more frequently in the midline group (27 % vs 0 %, P = 0.02). Staphylococcus epidermidis and Candida albicans were the most common microbial isolates from deep abscesses. Multivariate logistic regression analysis revealed donor age 40 years or older (P = 0.04), the occurrence of a bladder leak (P = 0.05), and a peak serum amylase in the 1st week of 1000 IU/l or greater (P - 0.02) to be independent risk factors for the development of wound complications. The type of incision, however, was not found to be an independent risk factor. Patient (90 % vs 83 %, P = NS), pancreas allograft (78 % vs 82 %, P = NS), and kidney allograft (83 % vs 70 %, P = NS) survival rates were similar for the midline and transverse groups. We conclude that the transverse incision is a reasonable alternative to the midline incision in simultaneous pancreas-kidney transplantation and it is presently the incision of choice at our institution. It offers excellent exposure and is associated with a similar wound complication rate and outcome when compared to the midline incision.