Impact of Prior DIEP Reconstruction on Living Donor Kidney Retrieval
Prior prophylactic mastectomy with DIEP flap reconstruction does not significantly complicate living donor kidney retrieval surgery when performed by experienced surgeons, though special surgical planning is required.
Anatomical Considerations and Surgical Planning
The Deep Inferior Epigastric Perforator (DIEP) flap reconstruction uses abdominal tissue and blood vessels that may overlap with the surgical field for kidney donation. Key considerations include:
- DIEP flap harvest involves dissection of the deep inferior epigastric vessels and perforators from the lower abdominal wall 1, 2
- Living donor kidney retrieval typically uses laparoscopic or "mini-open" approaches as recommended by the American College of Kidney Diseases 3, 4
- Preoperative imaging is essential - CT angiography is mandatory to assess both renal anatomy and previous surgical changes to the abdominal wall vasculature 3, 4
Surgical Approach Modifications
The standard approach may need modification:
- The left kidney is generally preferred for laparoscopic donor nephrectomy due to the longer venous pedicle 4
- Previous DIEP reconstruction may necessitate adjustments to port placement during laparoscopy to avoid areas of previous dissection
- Hand-assisted laparoscopy or "mini-open" techniques remain viable options with appropriate planning 3
- Traditional open nephrectomy may be considered if extensive adhesions are anticipated, though this should be a last resort 4
Potential Complications
While DIEP flap surgery itself has a low complication rate (0.6% total flap loss) 1, 2, several considerations exist for subsequent kidney donation:
- Abdominal wall weakness or hernia is rare after DIEP (0.2% in large series) 1 but could affect surgical approach
- Altered abdominal wall vasculature may require careful dissection
- Previous abdominal surgery increases the risk of adhesions that could complicate laparoscopic access
Perioperative Management
Special attention should be paid to:
- Thorough preoperative evaluation including detailed imaging of both renal anatomy and previous surgical changes 4
- Selection of surgeons with adequate experience in complex donor nephrectomy 3
- Appropriate anesthetic management with consideration of regional techniques for pain control 4
- Careful perioperative discontinuation of any dietary supplements that may increase bleeding risk 3
Conclusion
With proper preoperative planning, imaging, and experienced surgical teams, prior DIEP flap reconstruction should not be a contraindication to living kidney donation. The key is thorough evaluation of the abdominal wall anatomy and appropriate surgical approach selection based on the individual's specific anatomical considerations.