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The Northeastern Society of Plastic Surgeons

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Teamwork Makes the Dream Work: Maximizing Surgical Opportunities in Living Donor Renal Transplantation
Brigit Baglien, Ledibabari Ngaage, MA Cantab MB BChir, Adekunle Elegbede, Erin Rada, MD, Silke Niederhaus, MD, Joseph Scalea, MD, Jonathan Bromber, MD, Yvonne Rasko, MD.
University of Maryland School of Medicine, Baltimore, MD, USA.

Background: Patients with obesity and end stage renal disease represent a surgical population with multiple comorbidities and high risk for postoperative complications. One method for reducing predisposition to postoperative adverse events in this patient population is to limit the number of operations. Emerging data suggests there is safety in combining indicated surgeries in select populations. Favorable outcomes have been reported for the combination of panniculectomy with renal transplantation, hernia repair, and gynecologic surgery. Methods: We conducted a retrospective review of adult patients at a single institution who underwent renal transplant, panniculectomy, and at least one additional abdominal or pelvic surgery concurrently. For those patients, we collected demographics, intraoperative variables, and postoperative data and analyzed surgical outcomes and postoperative complications. Results: Thirteen patients met inclusion criteria. These patients were 33 to 70 years old with mean body mass indices (BMI) of 36.2 4.9 kg/m2 [range: 27.9 - 43.1]. Patients underwent an average of 3.15 procedures [range: 3 - 5] with a mean hospital length of stay of 5.3 2.3 days [range: 3 - 10]. Overall, 8 patients experienced complications in the first 90 postoperative days (61.5%). There was one mortality. The wound complication rate was 46.2%, the overall readmission rate within 90 days was 38.5%, and the reoperation rate was 30.8%. All patients experienced immediate graft function and the 12 patients that survived to postoperative day 90 maintained survival at 1 year. Conclusion: This study demonstrates combined surgeries are performed occasionally with acceptable outcomes.


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