Prophylactic onlay reinforcement with absorbable mesh (polyglactin) is associated with less early wound complications after kidney transplantation: A preliminary study

Michalski, Christoph; Mohammadi, Sara; Khajeh, Elias; Ghamarnejad, Omid; Sabagh, Mohammadsadegh; Pianka, Frank; Golriz, Mohammad; Kulu, Yakup; Kallinowski, F.; Zeier, Martin; Morath, Christian; Büchler, Markus W.; Mehrabi, Arianeb

doi:10.1002/jbm.b.34366

Cited by 5 publications

(6 citation statements)

References 41 publications

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“…However, to identify in which group of at-risk patient's prophylactic mesh should be recommended, the authors conclude that further studies are needed. In contrast, the existing literature on the prophylactic use of mesh for wall closure in the context of renal transplantation is very scarce [20,21,22]. Of the 3 articles identi ed, 2 of them refer to their use for the prevention or treatment of compartment syndrome in renal transplantation [20,21].…”

Section: Discussionmentioning

confidence: 99%

Prevention of Incisional Hernia after Kidney Transplantation: Study Protocol for a Randomized Controlled Trial

Gómez-Dos-Santos

Plaza

Villar

et al. 2023

Preprint

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Background: Incisional hernia is a common complication after kidney transplantation with an incidence of 1.6-18%. Concerning non-transplant patients, a recently published meta-analysis describes a reduction of the incidence of incisional hernia of up to 85% due to prophylactic mesh replacement in elective, midline laparotomy. The aim of our study is to show a reduction of the incidence of incisional hernia after kidney transplantation with minimal risk for complication. Methods/design: This is a blinded, randomized controlled trial comparing time to incisional hernia over a period of 24 months between patients undergoing kidney transplantation and standardized abdominal closure with or without prophylactic placement of ProGrip™ (Medtronic. Fridley, Minnesota. USA) mesh in an onlay position. As we believe that the mesh intervention is superior to the standard procedure in reducing the incidence of hernia, this is a superiority trial. Discussion: The high risk for developing incisional hernia following kidney transplantation might be reduced by prophylactic mesh placement. ProGrip™ mesh features polylactic acid (PLA) microgrips that provides immediate, strong and uniform fixation. The use of this mesh combines the effectiveness demonstrated by the macropore propylene meshes in the treatment of incisional hernias, a high simplicity of use provided by its capacity for self-fixation that doesn´t increase significantly surgery time, and safety. Trial registration: ClinicalTrials.gov. ID: NCT04794582. Registered on 08 March 2021. Protocol version 2.0. (02-18-2021)

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Section: Discussionmentioning

confidence: 99%

Prevention of Incisional Hernia after Kidney Transplantation: Study Protocol for a Randomized Controlled Trial

Gómez-Dos-Santos

Plaza

Villar

et al. 2023

Preprint

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“…This approach appears to have a lower IH formation risk of 3.2% at a median follow-up of 59 months [55]. To date, there has been only 1 report of case series on the use of a prophylactic mesh in renal transplantation [56].…”

Section: Transplantationmentioning

confidence: 99%

Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review

García-Ureña

Berrevoet²,

Cuccurullo³

et al. 2021

Hernia

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Purpose Incisional ventral hernias (IHs) are a common complication across all surgical specialities requiring access to the abdomen, pelvis, and retroperitoneum. This public health issue continues to be widely ignored, resulting in appreciable morbidity and expenses. In this critical review, the issue is explored by an interdisciplinary group. Methods A group of European surgeons encompassing representatives from abdominal wall, vascular, urological, gynecological, colorectal and hepato-pancreatico-biliarysurgery have reviewed the occurrence of His in these disciplines. Results Incisional hernias are a major public health issue with appreciable morbidity and cost implications. General surgeons are commonly called upon to repair IHs following an initial operation by others. Measures that may collectively reduce the frequency of IH across specialities include better planning and preparation (e.g. a fit patient, no time pressure, an experienced operator). A minimally invasive technique should be employed where appropriate. Our main recommendations in midline incisions include using the 'small bites' suture technique with a ≥ 4:1 suture-to-wound length, and adding prophylactic mesh augmentation in patients more likely to suffer herniation. For off-midline incisions, more research of this problem is essential. Conclusion Meticulous closure of the incision is significant for every patient. Raising awareness of the His is necessary in all surgical disciplines that work withing the abdomen or retroperitoneum. Across all specialties, surgeons should aim for a < 10% IH rate.

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“…94 However, even in high-risk patients, the use of prophylactic mesh for abdominal wall closure in renal transplantation is still controversial, since immunosuppression may increase the risk of mesh infection, and the presence of the mesh could make future explorations of the iliac fossa more difficult. 7,72,[95][96][97][98][99] Recently, Michalski et al 100 evaluated the impact of prophylactic absorbable polyglactin mesh reinforcement on the incidence of short-term post-RT wound complications in 23 patients; when compared with 46 RT patients without preventive onlay mesh reinforcement, RT patients undergoing mesh reinforcement had a lower, although not significant, rate of early postoperative wound complications and were not at higher risk of developing SSI. 100 In patients with suspected RTCS not suitable for mesh repair, subcutaneous, 95 or intraperitoneal 86,96 placement of the graft are alternative methods of abdominal closure since they are associated with a low rate of complications and RTCS.…”

Section: Abdominal Wall Closurementioning

confidence: 99%

“…7,72,[95][96][97][98][99] Recently, Michalski et al 100 evaluated the impact of prophylactic absorbable polyglactin mesh reinforcement on the incidence of short-term post-RT wound complications in 23 patients; when compared with 46 RT patients without preventive onlay mesh reinforcement, RT patients undergoing mesh reinforcement had a lower, although not significant, rate of early postoperative wound complications and were not at higher risk of developing SSI. 100 In patients with suspected RTCS not suitable for mesh repair, subcutaneous, 95 or intraperitoneal 86,96 placement of the graft are alternative methods of abdominal closure since they are associated with a low rate of complications and RTCS. 100 Veroux et al 86 described an interesting case of iliocaval thrombosis as a consequence of inferior vena cava compression by a large-for-size kidney transplant.…”

Section: Abdominal Wall Closurementioning

confidence: 99%

“…100 In patients with suspected RTCS not suitable for mesh repair, subcutaneous, 95 or intraperitoneal 86,96 placement of the graft are alternative methods of abdominal closure since they are associated with a low rate of complications and RTCS. 100 Veroux et al 86 described an interesting case of iliocaval thrombosis as a consequence of inferior vena cava compression by a large-for-size kidney transplant. After an urgent relaparotomy, the graft was finally placed in the peritoneal cavity, with progressive resolution of venous thrombosis.…”

Section: Abdominal Wall Closurementioning

confidence: 99%

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Abdominal wall complications after kidney transplantation: A clinical review

Gioco

Sanfilippo

Corona

et al. 2021

Clinical Transplantation

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Introduction Abdominal wall complications are common after kidney transplantation, and although they have a minor impact on patient and graft survival, they increase the patient's morbidity and may have an impact on quality of life. Abdominal wall complications have an overall incidence of 7.7–21%. Methods This review will explore the natural history of abdominal wall complications in the kidney transplant setting, with a special focus on wound dehiscence and incisional herni, with a particular emphasis on risk factors, clinical characteristics, and treatment. Results Many patient‐related risk factors have been suggested, including older age, obesity, and smoking, but kidney transplant recipients have an additional risk related to the use of immunosuppression. Wound dehiscence usually does not require surgical intervention. However, for deep dehiscence involving the fascial layer with concomitant infection, surgical treatment and/or negative pressure wound therapy may be required. Conclusions Incisional hernia (IH) may affect 1.1–18% of kidney transplant recipients. Most patients require surgical treatment, either open or laparoscopic. Mesh repair is considered the gold standard for the treatment of IH, since it is associated with a low rate of postoperative complications and an acceptable rate of recurrence. Biologic mesh could be an attractive alternative in patients with graft exposition or infection.

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Prophylactic onlay reinforcement with absorbable mesh (polyglactin) is associated with less early wound complications after kidney transplantation: A preliminary study

Cited by 5 publications

References 41 publications

Prevention of Incisional Hernia after Kidney Transplantation: Study Protocol for a Randomized Controlled Trial

Prevention of Incisional Hernia after Kidney Transplantation: Study Protocol for a Randomized Controlled Trial

Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review

Abdominal wall complications after kidney transplantation: A clinical review

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