Incisional hernia after liver transplantation: risk factors and health‐related quality of life

Abstract

The aim of this cross-sectional study was to analyze the incidence of incisional hernia after liver transplantation (LT), to determine potential risk factors for their development, and to assess their impact on health-related quality of life (HRQoL). Patients who underwent LT through a J-shaped incision with a minimum follow-up of three months were included. Follow-up was conducted at the outpatient clinic. Short Form 36 (SF-36) and body image questionnaire (BIQ) were used for the assessment of HRQoL. A total of 140 patients was evaluated. The mean follow-up period was 33 (SD 20) months. Sixty patients (43%) were diagnosed with an incisional hernia. Multivariate analysis revealed surgical site infection (OR 5.27, p = 0.001), advanced age (OR 1.05, p = 0.003), and prolonged ICU stay (OR 1.54, p = 0.022) to be independent risk factors for development of incisional hernia after LT. Patients with an incisional hernia experienced significantly diminished HRQoL with respect to physical, social, and mental aspects. In conclusion, patients who undergo LT exhibit a high incidence of incisional hernia, which has a considerable impact on HRQoL. Development of incisional hernia was shown to be related to surgical site infection, advanced age, and prolonged ICU stay.

Incisional hernia after open resections for colorectal liver metastases – incidence and risk factors

“…impaired health-related quality of life compared to those without hernia. 28 Another weakness is that the size of the bites for abdominal closure was not standardized among operating surgeons, which has been shown to influence the hernia rate. 29 In conclusion, this study on patients operated for colorectal liver metastases showed that prolonged preoperative chemotherapy and also preoperative bevacizumab were strong predictors for developing an incisional hernia.…”

Development and Validation of a Risk Stratification Score for Ventral Incisional Hernia after Abdominal Surgery: Hernia Expectation Rates in Intra-Abdominal Surgery (The HERNIA Project)

“…Several studies have evaluated VIH risk after specific procedures, such as transplant or cardiac surgery, but the applicability to other procedures is unknown. 7,8,9 Two recent prospective studies of patients undergoing elective and urgent abdominal surgery have identified risk factors for VIH following open abdominal surgery. 10,11 Itatsu et al followed over 4000 consecutive patients while Veljkovik et al used a cohort of 603 patients to develop and validate a hernia risk scoring system equation.…”

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“…1,[3][4][5][6][7][8][9][11][12][13][14][15][16][17][18][19][20] Several studies have suggested that SSI after kidney transplant is a risk factor for incisional hernias. [24][25][26][27][28][29][30][31][32] The association between SSI and incisional hernias was verified in this study. Surgical site infection is also considered to be an important risk factor contributing to the development of incisional hernias in nontransplanted patients.…”

“…19,20,27 Delayed graft function is thus associated with lower graft survival, longer hospital stay, higher costs, and increased psychologic and significant medical sequelae. [17][18][19][20][21][24][25][26][27][28][29][30] In patients with DGF, hemodialysis itself is an additional oxidative stress. The need for even 1 dialysis session posttransplant creates a milieu that affects B and T cells, which can lead to impaired wound healing and/or wound breakdown.…”

“…26 Older donors also have a greater association with DGF, in part because older kidneys react poorly to acute kidney injury. [24][25][26][27][28][29][30] The lower physiologic reserve tempers the ability to recover from insult. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]24,25,27,28 We did not see a correlation between incisional hernias and obesity.…”