Comparison of J-Shaped Incision and Mercedes Incision for Liver Transplantation

Abstract

Wound-related and incision-related complications such as wound infections and incisional hernias are common after liver transplantation. Advances in surgical, anesthesiological, critical care, and immunological innovations have led to a dramatic reduction in postoperative morbidity and mortality. Orthotopic liver transplant (OLT) has been first described with traditionally Mercedes type incision. Less traumatic J shaped incision has been used more frequently. We analyzed retrospectively 110 consecutive patients submitted to OLT in our institution from November 2010 to December 2012. In our program, beginning on September 2011, orthotopic liver transplantation (OLT) was performed using J-shaped (J) incision routinely, switching from a previous Mercedes (M) incision. We compared the incidence for surgical site infection (SSI), incisional hernia, and overall satisfaction. Fifty patients submitted to OLT using J-shaped incision were compared to 60 patients with M incision. Age, sex distribution, indication for OLT, and MELD score were similar in both groups. Three patients in the J group developed SSI, 6%, while 13, 21.6%, patients in the M group developed SSI (p=0.02). Incisional hernia was observed in 9 patients in the J group, 18%, compared with 22 patients in M group, 36.6% (p=0.03). Regarding overall satisfaction with the results of the incision, 48 patients, 96%, in J group gave the highest score, while in the M group, 45 patients, 75%, attributed the highest score for the questionnaire. After we have decided to switch from Mercedes type incision to J-shaped incision, OLT was feasible in all patients. When refraining to incise rectus abdominis on both sides, we provide a less traumatic incision, which leads to fewer complications postoperatively. Our results suggest that a J-shaped incision is preferred to other incisions for OLT.