Laparoscopic repair of incisional hernia in solid organ-transplanted patients: the method of choice?

Abstract

Summary Due to immunosuppressive (IS) therapy, incisional hernias are overrepresented in the organ‐transplanted (Tx) population with larger defects, a high rate of recurrence, and a tendency toward more seromas and infectious problems. Thirty‐one Tx/IS patients with a control group of 70 non‐IS patients with incisional hernia (6/7 recurrences) were included in a prospective interventional study. Both cohorts were treated with laparoscopic ventral hernia repair (LVHR). Follow‐up time and rate was 37 months and 95%. One hundred LVHR's were completed as there was one conversion in the Tx/IS group. No late infections or mesh removals occurred. Recurrence rates were 9.7% vs. 4.2% (P = 0.37) and the overall complication rates were 19% vs. 27% (P = 0.80). The Tx/IS group had a higher mesh‐protrusion rate (29% vs. 13%, P = 0.09), but also larger hernias. Polycystic kidney disease was overrepresented in the Tx cohort (44% of kidney‐Tx). Incisional hernias in Tx/IS patients may be treated by LVHR with the same low complication rate and recurrence rate as non‐IS patients. By LVHR, the highly problematic seroma/infection problems encountered in Tx/IS patients treated by conventional open technique seem almost eliminated. The minimally invasive procedure seems particularly rational in the Tx/Is population and should be the method of choice. (ClinicalTrials.gov number: NCT00455299, date: 5 May 2006).

Open or laparoscopic mesh repair of incisional hernia in patients that underwent liver transplantation: A systematic review and proportional meta‐analysis

“…Similar results were observed in the study of Kurmann et al, where the laparoscopic group included 13 patients, 1 of which presented wound infection and 1 hematoma 32 . On the other hand, Lambrecht et al and Weiss et al presented only laparoscopic repair of the incisional hernia with mesh; 31,33 the first study included 101 patients with 30 complications and the second 54 patients with 19 complications.…”

“…Eighteen studies were included in our systematic review, 8,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] which involved 546 patients after liver transplant, who underwent incisional hernia repair with mesh placement. 144 (26%) of these patients presented postoperative complications.…”

Outcomes Following Colorectal Resection in Kidney Transplant Recipients

“…[2,9] Our findings are consistent with longer LOS documented in other smaller, single institutions studies of transplant recipients undergoing general surgical procedures. [10,11,26] Additionally, we reported significantly higher cost for kidney transplant recipients compared to non-transplant recipients. A recent national study of colectomy reported median costs ranging from $12,071 – 14,141 depending on surgical approach for the general population, which is similar to our finding of median cost of $14,139 for non-transplant recipients.…”

“…[1] As with other types of general surgery in KTR, single-institution case series have demonstrated a prolonged length of stay (LOS) following colorectal resection, with one study reporting a median LOS of 22.2 days compared to a national average of 9.3 days for open colectomy. [6,9–11] Given concerns of increased operative risk, it has been suggested that any increased morbidity, LOS or cost might be reduced if transplant recipients receive their surgical care at transplant centers. [12–14]…”

Reconstrucción de la pared abdominal en pacientes con inmunosupresión: experiencia en una institución de alta complejidad

“…Esta última cobra relevancia, al considerar que estudios previos han mostrado que entre un 2 % y un 10 % de todos los pacientes llevados a una Reparación de Hernia Ventral (RHV), padecen de alguna clase de inmunosupresión (primaria o secundaria) al momento de la intervención quirúrgica. Se ha encontrado que, en pacientes trasplantados (estado común relacionado con la inmunosupresión secundaria), la prevalencia de HI alcanza hasta el 45 % en algunas series 4,8,9 .…”