You have accessJournal of UrologyRenal Transplantation & Vascular Surgery I (MP37)1 Sep 2021MP37-10 ANTERIOR RECTUS SHEATH VERSUS GIBSON APPROACH TO KIDNEY TRANSPLANTATION: A RANDOMIZED CONTROLLED TRIAL Prithvi Murthy, Michele Fascelli, Madison Lyon, Eric Miller, Yi-Chia Lin, Michael Spinner, Venkatesh Krishnamurthi, Alvin Wee, David Goldfarb, Joseph Africa, and Mohamed Eltemamy Prithvi MurthyPrithvi Murthy More articles by this author , Michele FascelliMichele Fascelli More articles by this author , Madison LyonMadison Lyon More articles by this author , Eric MillerEric Miller More articles by this author , Yi-Chia LinYi-Chia Lin More articles by this author , Michael SpinnerMichael Spinner More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Alvin WeeAlvin Wee More articles by this author , David GoldfarbDavid Goldfarb More articles by this author , Joseph AfricaJoseph Africa More articles by this author , and Mohamed EltemamyMohamed Eltemamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002046.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The anterior rectus sheath (ARS) approach to kidney transplantation (KT) involves a small paramedian incision to divide the ARS and medially retract the rectus body without cutting muscle, permitting iliac vasculature exposure and creation of a buried retroperitoneal pocket for the graft (Fig. 1). Retrospective literature demonstrated decreased wound related complications with ARS compared to the Gibson approach (GA). We present results from a randomized double blind controlled trial comparing ARS to GA. METHODS: Patients ≥age 18 without prior ipsilateral KT were enrolled. Surgeons randomized patients intraoperatively. Patients were blinded to randomization. Data collection/analysis was blinded. Student’s t-test, Chi square and the Mann-Whitney-U test were used to compare continuous, categorical, and ordinal non-normally distributed data, respectively. The primary endpoint was wound related complication differences. Post operative pain and narcotic use were secondary endpoints. Estimating a 35% incidence of wound complications, 72 patients per arm would achieve 80% power to detect a 20 point decrease in complications with a two sided α of 0.05. RESULTS: 75 patients were enrolled per arm. Table 1 displays demographic, peri-operative and wound data. Median follow up was 12.5 months. Operative time, benched kidney volumes, post-operative pain, length of stay and delayed graft function rates did not differ. The ARS group had smaller incisions (9.8 cm vs. 13.8 cm, p<0.01) and less inpatient oral morphine equivalent use (75.7 mg vs. 142.2 mg p=0.048). 7 (9%) patients in ARS and 5 (7%) in GA had wound complications. 2 patients in ARS and 4 in GA had a ≥ Clavien-Dindo (CD) IIIa wound complication. CD distribution did not differ between groups (p=0.43). CONCLUSIONS: The wound related complication rate did not differ between the ARS and GA groups and was lower than anticipated. Patients undergoing ARS have shorter incisions and require less inpatient narcotic use despite having similar subjective reporting of pain. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e649-e650 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Prithvi Murthy More articles by this author Michele Fascelli More articles by this author Madison Lyon More articles by this author Eric Miller More articles by this author Yi-Chia Lin More articles by this author Michael Spinner More articles by this author Venkatesh Krishnamurthi More articles by this author Alvin Wee More articles by this author David Goldfarb More articles by this author Joseph Africa More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement Loading ...