Surgical clips or staples?

[mom2three]

I was reading old posts from early October and saw Snoopy post that his surgeon informed him they don't use internal clips anymore due to possible slippage and that they use staples.  What do other donors have? Clips or staples?

My surgery was done Jun 2010 and I have surgical grade metal clips.  Just curious!

[WilliamLFreeman]

mom2three & y'all,

The concern is that the supposedly-closed renal artery suddenly "blows" open, and the donor has massive internal bleeding from the now-open major artery that can kill the person in a short period of time if not stopped.

Most important:  Any donor who has not had such bleeding in the first week or so after the donation surgery is safe; by then, the body has formed scar tissue around the artery's end, and the possibility of massive internal bleeding from then on is zero.   

The basic options the surgeon has to close the renal artery are 4:  1] clips not "Hem-o-lok";  2] staples;  3] suture (= tie by suture or surgical thread, typical silk or artificial); or  4] "Hem-o-lok" brand clips.  The "clips" in #1] can be locking or not locking -- and can be metal or plastic --  and a single or multiple clips can be put one the same renal artery.  (Multiple is safer than single.)  All 4 options can be done "with transfixion" or without.  ("With transfixion" means that after the renal artery is occluded or closed, the stump of the artery is attached to another, stable, tissue or organ, so that it is not just "floating free"; the organ or tissue of attachment might be the back of the abdominal cavity, for instance.)

The "Hem-o-lok" clips are in its own separate category, because that brand of clip has the highest risk of failure after a donor's kidney is taken out.  The FDA had announced several years ago that Herm-o-lok clips were not to be used in donor surgery due to that fact.  Nevertheless, at least 2 (and I think 3, & possibly more) deaths due to failure of the Hem-o-lok clips causing massive, fatal, internal bleeding have occured in the past 5 years.  The last death was less than 12 months ago.   

Snoopy's surgeon and transplant team knew that, although Hem-o-lok clips have the highest failure rate, other clips may not be as safe is another method.  "With transfixion" increases the safety of every method.

A point for about-to-be-donors.  The biggest risk of massive internal bleeding is within the first 24 hours after surgery.  I recommend you ask your surgeon when is the earliest you will be discharged.  If the answer is "within 24 hours," or if in fact the surgeon within 24 hours post-op says you are ready to be discharged, you can object and give as the reason that "the risk of massive internal bleeding is the highest within that time, and you want to be in-hospital on a 'surgical floor' where the nurses have special skill in recognizing such a rare -- but life-threatening -- event, the only treatment for which is an immediate surgical operation to stop the internal bleeding."  I think the safest is to be discharged at or after 48 hours post-op.

Bill

[mom2three]

Thanks Bill. That was a great explanation and good advice for up and coming donoros to make sure the their post-op lengths of stay are adequate.  After re-reading my op note I see my renal artery was stapled and then clipped twice (though not transfixed). It's always reassuring to hear the science behind the outcome. Thanks.