Prosthetic repair of incisional hernia in kidney transplant patients. A technique with onlay polypropylene mesh

Abstract

The employment of synthetic mesh for incisional hernia repair in kidney-transplanted patients is rarely reported in the present literature. Many authors believe that mesh employment in such conditions is not safe due to fear of mesh related complications. From 1965 through 1999, a total of 1685 kidney transplants were performed at our Kidney Transplant Unit and 19 patients developed eventrations in the kidney transplant incision, an incidence of 1.1%. From September 1996 eight of these patients had prosthetic repair of the abdominal wall with onlay polypropylene mesh. All patients were under immunosuppressive therapy with prednisone, ciclosporine and azathioprine. Mean age was 48.8 years, mean body mass index was 22.5 and mean number of previous abdominal operations was 2.5. A large polypropylene mesh (Marlex mesh) was fixed over the aponeurosis after primary closure of the aponeurotic borders, as an onlay graft. There was neither morbidity nor mortality associated to the surgical procedure. No recurrences or long-term complications associated with mesh employment were verified after a follow-up ranging from one year to three years. We concluded that prosthetic repair of incisional hernia in transplanted patients can be performed routinely.

Incision length for kidney transplantation does not influence short‐ or long‐term outcome: a prospective randomized controlled trial

“…Looking at incisional complications, the overall rate of incisional hernia (8.6%), which lies within the rates reported in the literature , did not differ between the two groups.…”

Polypropylene and polypropylene/polyglecaprone (Ultrapro(r)) meshes in the repair of incisional hernia in rats

“…A 4cm midline skin incision was made and subcutaneous tissue dissected from the muscle fascia transversely and vertically, 1.5cm on each side of the incision. A 3cm midline incision was made on the muscular fascias and peritoneum, followed by subsequent skin closure using non-resorbable 4-0 nylon 9,10 . easily undone by manipulation; Degree 2) Stable adhesions, between intestinal loops, not involving the abdominal wall, resistant to manipulation; Degree 3) Stable adhesions, between the abdominal wall and an organ or a structure, resistant to manipulation; Degree 4) Stable adhesions, between the abdominal wall and more than an organ or structure, resistant to manipulation;…”

Postoperative complications after laparoscopic incisional hernia repair

“…However, it is not clear where to place the mesh. Although there are some hints that the subfascial placement may be adequate [10,17], some studies deal with the onlay technique [2,3]; the IPOM technique is also used [7,20]. The main disadvantage of the conventional repair, irrespective of the localization of the mesh, is the necessity of creating large flaps of the abdominal wall layers, which imposes a tremendous trauma to the abdominal wall.…”