The Use of a Polyglactin 910 Mesh to Obtain Haemostasis and Prevent Further Splitting in a Fractured Transplant Kidney

BACKGROUND

Bleeding due to cortical tears in a transplant kidney is a rare, but potentially serious, complication. Friable and oedematous tissue will often not take sutures and bleeding may not be controlled with fibrin glue, thrombin haemostatic matrix (Floseal®) or oxidised, regenerated cellulose (Surgicel®). These products will also not prevent further fracturing if the kidney becomes engorged.

TECHNIQUE

The kidney is exposed and inspected for bleeding points. Any haematoma must be evacuated. If the kidney is viable but with cortical tearing, direct pressure is applied. Flowseal can be applied to the fracture site. An appropriately sized absorbable mesh is divided in the midline to a distance of roughly two-thirds of its length. The cut surface of the mesh is laid around the hilum of the kidney with care not to obstruct the vessels or ureter (Fig. 1). The outer edges of the mesh are drawn together over the cortex of the kidney and loosely sutured together using a continuous PDS stitch, so there is no cortical hypoperfusion. The kidney is then re-inspected for vascular insufficiency and two suction drains are placed adjacent to the hilum. The patient must be closely observed postoperatively for evidence of re-bleed and postoperative biopsy must be avoided.

Figure 1.

A kidney has been wrapped in absorbable mesh after the upper pole has fractured in three places (Surgicel applied to upper pole under mesh).

DISCUSSION

This technique is a viable option for haemostasis and the prevention of fracturing in a transplanted kidney. It can be used to avoid transplant nephrectomy without compromising vascularity and function.