BACKGROUND: Incisional hernia after liver transplantation is a common complication with an incidence between 5% and 34%. This prospective study analyzed risk factors, surgical management and long-term results after hernia repair. MATERIAL AND METHODS: From February 2002 until August 2009, 810 liver transplantations were performed. 77 patients (9.5%) underwent incisional hernia repair after a median time of 21.1 months (4.6-76.7) following transplant. These patients were compared to patients without hernia (n=733). RESULTS: No statistically significant differences between the groups were observed with respect to gender, underlying liver disease, Child-Pugh classification, MELD-Score and preoperative renal failure (p=NS). Multivariate analysis revealed advanced age (p=0.014), body mass index (p=0.016), and re-laparotomies (p<0.001) as independent risk factors for incisional hernias. Pre-existing diabetes mellitus and immunosuppression with mycophenolate mofetil reached significance only in the univariate analysis (p<0.001). Recurrent hernia was observed in 12 of 77 patients (15.6%) at a median time of 7.9 months (4.8-46.8) after primary surgical repair. The recurrence rate after intraperitoneal onlay mesh implantation was lower compared to other mesh techniques (7.7% vs. 21.4%). CONCLUSIONS: The risk factors for the development of incisional hernias in liver transplant patients are similar to patients with prior abdominal surgery for other reasons. Intraperitoneal onlay mesh implantation may lead to a decrease of hernia recurrences. The role of immunosuppression in the genesis of incisional hernias requires further elucidation.
BACKGROUND: Incisional hernia after liver transplantation is a common complication with an incidence between 5% and 34%. This prospective study analyzed risk factors, surgical management and long-term results after hernia repair. MATERIAL AND METHODS: From February 2002 until August 2009, 810 liver transplantations were performed. 77 patients (9.5%) underwent incisional hernia repair after a median time of 21.1 months (4.6-76.7) following transplant. These patients were compared to patients without hernia (n=733). RESULTS: No statistically significant differences between the groups were observed with respect to gender, underlying liver disease, Child-Pugh classification, MELD-Score and preoperative renal failure (p=NS). Multivariate analysis revealed advanced age (p=0.014), body mass index (p=0.016), and re-laparotomies (p<0.001) as independent risk factors for incisional hernias. Pre-existing diabetes mellitus and immunosuppression with mycophenolate mofetil reached significance only in the univariate analysis (p<0.001). Recurrent hernia was observed in 12 of 77 patients (15.6%) at a median time of 7.9 months (4.8-46.8) after primary surgical repair. The recurrence rate after intraperitoneal onlay mesh implantation was lower compared to other mesh techniques (7.7% vs. 21.4%). CONCLUSIONS: The risk factors for the development of incisional hernias in liver transplant patients are similar to patients with prior abdominal surgery for other reasons. Intraperitoneal onlay mesh implantation may lead to a decrease of hernia recurrences. The role of immunosuppression in the genesis of incisional hernias requires further elucidation.
Authors: Carter T Smith; Micah G Katz; David Foley; Bridget Welch; Glen E Leverson; Luke M Funk; Jacob A Greenberg Journal: Surg Endosc Date: 2014-08-15 Impact factor: 4.584
Authors: L Tastaldi; J A Blatnik; D M Krpata; C C Petro; A Fafaj; H Alkhatib; M Svestka; S Rosenblatt; A S Prabhu; M J Rosen Journal: Hernia Date: 2019-02-21 Impact factor: 4.739
Authors: James R Butler; Daniel C O'Brien; Joshua K Kays; Kyle Ridlen; Chandrashekhar A Kubal; Burcin Ekser; Lava Timsina; Jonathan A Fridell; Richard S Mangus; John A Powelson Journal: Surg Open Sci Date: 2019-06-29
Authors: Lucas Torres Oliveira; Felipe Futema Essu; Gustavo Heluani Antunes de Mesquita; Yuri Justi Jardim; Leandro Ryuchi Iuamoto; Fábio Yuji Suguita; Diego Ramos Martines; Fernanda Nii; Daniel Reis Waisberg; Alberto Meyer; Wellington Andraus; Luiz Augusto Carneiro D'Albuquerque Journal: Int J Surg Case Rep Date: 2017-10-12
Authors: Lucas Faraco Sobrado; Lucas Ernani; Daniel Reis Waisberg; Luiz Augusto Carneiro-D'Albuquerque; Wellington Andraus Journal: Int J Surg Case Rep Date: 2020-06-16