A kidney organ implantation procedure is a complex procedure taking 3-5 hours to complete. It involves working in restricted quarters in the bony pelvis and hand-sewing kidney donor artery and vein blood vessels to recipient pelvic blood vessels. Following this, a new hole is made in the bladder and the donor ureter is sewn to this location.
As the operation requires work around the large blood vessels in the pelvis and the ones that supply the leg, injury to these structures could potentially result in need for expansion of the incision and operation in order to get control of the bleeding in safe and timely fashion. Bleeding can also occur from the kidney itself either during the procedure or sometime afterwards in the early postoperative period, as vessels of the kidney may be in spasm due to the procurement or cold storage phase, and only open up at a later time to bleed internally.
The process of making a new hole in the recipient artery and vein to accommodate the donor vessels can be complicated due to vascular disease in the recipient vessels. This is very common in diabetics and hypertensive patients who may have a lot of arterial narrowing and calcifications in the wall of the artery. Attempting to make a hole in arteries such as this may propagate a “flap” of the artery which can split the artery internally downstream, or up into the kidney and cause ischemia of the kidney or the leg. This may then require rather extensive vascular reconstructive surgery on either the kidney or pelvic and leg vessels or both in order to remedy this situation.
The pelvis and exit of the structures out of the pelvis represents a concentration of anatomic strutures narrowing to this level before branching out again. As such, there are many critical structures which are located close together. While working on one area, other structures such as nerves or muscles might be injured with thermal injury, or sharp dissection injury causing potentially permanent disability. This may result in sensory nerve impacts such as a feeling of deadness or numbness or “pins and needles” in the front of the thigh, abdomen or pelvis. Motor nerve injury to nerves such as the obturator nerve may result in difficulty moving the thigh towards the centerline of the body.
Warning Signs: Wounds
If your incision develops increasing pain, shows discharge of whitish/greyish/greenish exudate, or shows redness creeping wider and wider around the incision, you should inform your physician for possibility of infection.
Generally speaking, you should continue to heal your wounds over the next 10-12 weeks and during this time, should try not to stress your incisions too much by performing activities which cause tension across the incision lines. For example, for most abdominal incisions, it is recommended not to doing any straining or lifting of anything heavier than 10lbs for 6-8 weeks minimum.
Warning Signs: Activity
If during coughing/laughing/straining/lifting/activity you note a “snapping” sound or sensation in or around the incision, and notice the development of increased fluid coming out of the wound or more bulging than was previously appreciated, notify your physician for possibility of hernia formation or more acutely, wound dehiscence (strength layer under the skin opening up) or evisceration (strength layer has been compromised and bowel is coming out of the incision).
With regards to diet, if your bowels have not returned to normal when you go home, you should continue to eat small meals more frequently rather than several large meals and wait for your bowels to get more regular. This typically takes anywhere from 5-10 days for most people. In the meantime, continue to replace your fluids with water and electrolytes, treat nausea with fresh air, activity and medication as required (Gravol, Maxeran, Stemetil) and suppress pain with medication as required.
Warning Signs: Bowels
If your bowels continue to not work and you suffer ongoing abdominal bloating to the point of extreme pain or intractable nausea and vomitting you should notify your physician for possibility of postoperative ileus (slow gut) or obstruction. As well, if you throw up fresh blood or have black, tarry stools, you should notify your physician for possibility of a gastrointestinal bleed.
For most procedures, a catheter will be placed temporarily via the urethra into the bladder for drainage of urine while you are recovering. The catheter will be removed for a “trial of voiding” to make sure you can pass your urine before you go home. If you are unable to do so, the catheter will be replaced and you will be asked to try again usually the next day.
Warning Signs: Urination
If you are unable to urinate for greater than 6 hours, although you have the urge to do so and increasing lower abdominal pain with distension, you should notify your physician for possibility of urinary retention requiring re-catherterization.
Also if you notice more than cranberry colored urine passing via urethra, urinary frequency, urgency or burning, you should notify your physician for possibility of urinary tract infection.
Warning Signs: General
If you notice sudden onset shortness of breath, crushing/squeezing chest pain, or chest pain radiating to the neck or arm, massive headache, or difficulty talking or walking; seek medical attention immediately.
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