Please use this identifier to cite or link to this item:
Title: Pre-gerotal fat patch-A novel alternative to haemostatic agents during partial nephrectomy.
Austin Authors: Timm, Brennan ;Thomson, Alice;Bolton, Damien M ;Pether, Michael
Affiliation: Bunbury Regional Hospital Bunbury Western Australia Australia.
Austin Health
Bunbury Regional Hospital Bunbury Western Australia Australia.
Issue Date: Nov-2023
Date: 2023
Publication information: BJUI Compass 2023-11; 4(6)
Abstract: This study aimed to determine if using a pre-gerotal fat patch at open partial nephrectomy (PN) as a haemostatic bolster is a viable alternative to using synthetic haemostatic agents. Human Research Ethics Committee approval was obtained for audit of a prospectively kept database from July 2012 to July 2021, which followed outcomes of patients who received a low-tension pre-gerotal fat patch renorrhaphy at open PN. Patient demographics, intraoperative measures, histological outcomes and post-operative complications were analysed. Using a retroperitoneal approach, the peritoneum was mobilised and a vascularised pedicle of pre-gerotal fat was rotated in the direction of the kidney. Routine definition of the hilum, clamping of the hilar vessels and dissection of mass followed. After watertight closure and haemostasis, the harvested pre-gerotal fat patch was placed over the defect and secured using low-tension renorrhaphy. Two-layer closure of the abdominal wall with placement of a drain was routine. A total of 55 patients underwent open PN. Mean age was 60.4 (35-77) years. There were 38 men and 17 women, and 32 right and 23 left PNs. Mean mass size was 31.9 mm (10-95 mm) and collecting system was breached in 36.5% of cases. One patient (1.9%) suffered a Clavien-Dindo IIIb complication requiring return to theatre and transfusion due to a bleed from an intercostal artery. There were no renal bed bleeds, urine leaks or urine fistulas detected. Mean intraoperative blood loss was 355 mL (50-1500 mL) and mean post-operative creatinine increased by 10.7 μmol/L (51-172 μmol/L). Mean follow up was 40.2 (4-109) months. Utilisation of an anatomical pre-gerotal fat patch to provide pressure at the renorrhaphy site during open PN is an effective technique to assist with surgical haemostasis. This simple technique avoids the costs of haemostatic agents, whilst adding minimal operating time to procedures.
DOI: 10.1002/bco2.264
ORCID: 0000-0001-6195-3364
Journal: BJUI Compass
Start page: 709
End page: 714
PubMed URL: 37818025
ISSN: 2688-4526
Type: Journal Article
Subjects: haemostatic bolster
minimally invasive surgery
open surgery
partial nephrectomy
pre‐gerotal fat patch
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on Dec 10, 2023

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.