Risk factors of severe incisional hernia after renal transplantation: a retrospective multicentric case–control study on 225 patients

Broggi, E; Bruyère, F.; Gaudez, F.; Desgrandchamps, F.

doi:10.1007/s00345-016-1971-7

Cited by 12 publications

(10 citation statements)

References 28 publications

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“…1125 patients received sirolimus while 6120 did not. Broggi et al [ 10 ] reported data in the form of an odds ratio rather than raw numbers and these patients have not been included in these numeric descriptors.…”

Section: Resultsmentioning

confidence: 99%

“…Further, closure method with single or multi-fascial closure does not appear to influence the rate of hernia formation. The recently published article by Broggi et al [ 10 ] suggests the single-layered parietal closure increases the odds of hernia formation by 2.89 times. It is unclear, however, how many patients in this group underwent single-layered parietal closure.…”

Section: Discussionmentioning

confidence: 99%

“…In transplant recipients, the association between factors thought to precipitate incisional hernia formation have been explored. These factors include increased recipient age or body mass index [ 7 ], an immunosuppressive regimen that includes sirolimus or mycophenolate mofetil (MMF) [ 8 ], Rutherford-Morrison transplant incision [ 9 ] and single layered closure [ 10 ]. In this meta-analysis, we aimed to assess the risk and factors contributing to incisional hernia formation in kidney and pancreas transplant recipients by synthesizing the evidence available in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Optimal surgical management in kidney and pancreas transplantation to minimise wound complications: A systematic review and meta-analysis

Shahrestani

Tran

Pleass

et al. 2018

Annals of Medicine and Surgery

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BackgroundImmunosuppression in transplant patients increases the risk of wound complications. However, an optimal surgical approach to kidney and pancreas transplantation can minimise this risk.Materials and methodsWe performed a systematic review and meta-analysis to examine factors contributing to incisional hernia formation in kidney and pancreas transplant recipients. Bias appraisal of studies was conducted via the Newcastle-Ottawa scale. We considered recipient factors, surgical methods, and complications of repair.ResultsThe rate of incisional hernia formation in recipients of kidney and pancreas transplants was 4.4% (CI 95% 2.6–7.3, p < 0.001). Age above or below 50 years did not predict hernia formation (Q (1) = 0.09, p = 0.77). Body mass index (BMI) above 25 (10.8%, CI 95% 3.2–30.9, p < 0.001) increased the risk of an incisional hernia. Mycophenolate mofetil (MMF) use significantly reduced the risk of incisional hernia from 11.9% (CI 95% 4.3–28.7, p < 0.001) to 3.8% (CI 95% 2.5–5.7, p < 0.001), Q (1) = 4.25, p = 0.04. Sirolimus significantly increased the rate of incisional hernia formation from 3.7% (CI 95% 1.7–7.1, p < 0.001) to 18.1% (CI 95% 11.7–27, p < 0.001), Q (1) = 13.97, p < 0.001. While paramedian (4.1% CI 95% 1.7–9.4, p < 0.001) and Rutherford-Morrison incisions (5.6% CI 95% 2.5–11.7, p < 0.001) were associated with a lower rate of hernia compared to hockey-stick incisions (8.5% CI 95% 3.1–21.2, p < 0.001) these differences were not statistically significant (Q (1) = 1.38, p = 0.71). Single layered closure (8.1% CI 95% 4.9–12.8, p < 0.001) compared to fascial closure (6.1% CI 95% 3.4–10.6, p < 0.001) did not determine the rate of hernia formation [Q (1) = 0.55, p = 0.46].ConclusionsWeight reduction and careful immunosuppression selection can reduce the risk of a hernia. Rutherford-Morrison incisions along with single-layered closure represent a safe and effective technique reducing operating time and costs.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimal surgical management in kidney and pancreas transplantation to minimise wound complications: A systematic review and meta-analysis

Shahrestani

Tran

Pleass

et al. 2018

Annals of Medicine and Surgery

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“…Factors associated with incisional hernia were a BMI > 30, age > 50, cadaveric graft and reoperation through the same incision [ 6 ]. Additionally, smoking, lymphocele and partial closure in a single musculofascial layer are other risk factors [ 8 ]. Immunosuppressives such as mTORi (a class of drugs that inhibit the mechanistic Target Of Rapamycine) are known to carry increased risk of incisional hernia formation [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Incarceration of transplanted kidney through incisional hernia

Nawabi

Marlor

Camarata

et al. 2021

Journal of Surgical Case Reports

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Transplanted allograft kidney herniation through an incisional hernia resulting in incarceration is a rare condition with only one other similar case reported in the literature. The primary imaging modalities used to diagnose kidney herniation are graft ultrasound, abdominal computed tomography and abdominal magnetic resonance imaging [Sugi et al. (Imaging of renal transplant complications throughout the life of the allograft: comprehensive multimodality review. Radiographics 2019;39:1327-1355)]. Treatment should be based on patient’s symptoms. This case report highlights the initial presentation of hematuria in a 57-year-old male that eventually led to the diagnosis of a right-sided incarcerated grafted kidney through an incisional hernia. Subsequently, the patient underwent transplant nephrectomy.

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“…La predisposición para la formación de una HI, está dada por factores de riesgo sistémicos y locales, ampliamente evaluados en estudios prospectivos y retrospectivos. Dentro de las predisposiciones sistémicas se encuentran el estado nutricional, la ictericia, la diabetes mellitus, la obesidad, el tabaquismo, alteración de las proteínas séricas, edad, género, uso crónico de esteroides y estados de inmunosupresión del paciente [1][2][3][4][5][6][7] . 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.…”

Section: Introductionunclassified

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

Márquez-Duque

Cabrera

2021

Rev Colomb Cir

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Introducción. Los pacientes con inmunosupresión llevados a cirugía abdominal convencional tienen un mayor riesgo de desarrollar hernias incisionales en el posoperatorio, y cuando ellas ocurren, es necesario individualizar el procedimiento quirúrgico de elección, según las características anatómicas, fisiológicas y clínicas de cada paciente. Este estudio describe las características demográficas y clínicas de los pacientes con inmunosupresión, llevados a reconstrucción de la pared abdominal, y sus desenlaces después de 30 días del procedimiento quirúrgico. Métodos. Serie de casos de pacientes con inmunosupresión llevados a reconstrucción de la pared abdominal, en un centro especializado de cuarto nivel de complejidad. Se incluyeron pacientes mayores de 18 años, operados en el período de enero de 2016 a diciembre de 2019. Resultados. Se presenta una serie de 18 pacientes, cinco (27,7 %) con algún tipo de inmunosupresión primaria y 13 (72,2 %) con algún tipo de inmunosupresión secundaria. La edad promedio fue de 56 años, 11 (61 %) fueron mujeres, el peso promedio de los participantes fue de 73,3 kg. Se encontraron complicaciones en ocho pacientes (44,4 %). Dos pacientes requirieron manejo en la Unidad de Cuidados Intensivos, por un máximo de tres días. Ninguno de los pacientes presentó recidiva de la hernia ni mortalidad. Discusión. La reconstrucción de la pared abdominal en pacientes inmunosuprimidos representa un reto para cualquier equipo quirúrgico debido a las condiciones especiales de los pacientes y a las variables asociadas al procedimiento. Las tasas de recidiva y de complicaciones de este estudio, se asemejan a las descritas en la literatura.

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Risk factors of severe incisional hernia after renal transplantation: a retrospective multicentric case–control study on 225 patients

Cited by 12 publications

References 28 publications

Optimal surgical management in kidney and pancreas transplantation to minimise wound complications: A systematic review and meta-analysis

Optimal surgical management in kidney and pancreas transplantation to minimise wound complications: A systematic review and meta-analysis

Incarceration of transplanted kidney through incisional hernia

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

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