SALVAGE SURGERY FOR ALLOGRAFT RUPTURE
Dr. SUNIL SHROFF
Department of Urology & Renal TransplantationSri Ramachandra Medical College & Research Institute (Deemed University) Chennai, India
ALLOGRAFT RUPTURE
Allograft Rupture
150 Renal Transplants 118 Live Related & 32 Cadavers
4 Allo-graft Ruptures 1 Cadaver & 3 Live Related
Cause of Allo-Graft Rupture
Vascular Rejection - 2
ATN – 1
Venous Thrombosis - 1
Salvage Surgery
In Three of the Graft Ruptures
Salvage Surgery Attempted
Salvage Surgery
In 2/3 Salvage Surgery Successful
( Vascular Rejection x 1 and ATN x 1)
In one patient with Venous Thrombosis salvage unsuccessful
Salvage Surgery for Allograft Rupture
Difficult
No Preset Surgical Techniques
Nothing much Available in surgical literature
Salvage Surgery for Allograft Rupture
All our graft rupture involved convex surface of the kidney
The steps of the surgery include Meticulous Clearance of all Hematoma surrounding the graft followed by a Complex Repair
Technique of Salvage Surgery for Allograft Rupture
Continuous Prolene ( 6/0 or 5/0 ) sutures on Renal capsule distant to the site of rupture were used
Strips of Muscle , peritoneum and Surgicel interposed in between Prolene Sutures to cover area of rupture
In one case super glue – Nectacryl was used for a persistent spot bleeder
Muscle Strip or Gelfoam or Peritoneal strip covering the Ruptured Graft
Allo-Graft Rupture On Convex Surface of
Kidney
Surgical Technique
For Salvaging Allo-Graft Rupture
Greater Omental Wrap
Proline sutures away from site of
Rupture
Surgical Techniqu
e For Salvaging Allo-Graft
Rupture
CONCLUSION
The surgery of saving a ruptured graft can be a daunting experience and exercise
It should however be first attempted before sacrificing the graft.
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