Staged abdominal closure after small bowel or multivisceral transplantation

Sheth, Jigna; Sharif, Khalid; Lloyd, Carla; Gupte, Girish; Kelly, D A; Goyet, Jean de Ville de; Millar, Alastair J. W.; Mirza, Darius F.; Chardot, Christophe

doi:10.1111/j.1399-3046.2011.01597.x

Cited by 38 publications

(39 citation statements)

References 29 publications

(50 reference statements)

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“…A primary tension-free closure of the abdominal wall is achievable in 50%-65% of patients (12). Although sometimes reduced-size grafts can be used to facilitate primary closure, various strategies have been introduced to reconstruct and enhance the abdominal domain.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…Although sometimes reduced-size grafts can be used to facilitate primary closure, various strategies have been introduced to reconstruct and enhance the abdominal domain. Some strategies that have been employed are usage of tissue expanders, staged abdominal closure with mesh, bioengineered skin equivalents, acellular dermal matrix, vascularized or nonvascularized rectus muscle fascia grafts, skin grafts, and vascularized abdominal wall transplantation from the same donor (12,13). Abdominal wall transplantation permits primary skin and abdominal wall closure without causing abdominal compartment syndrome.…”

Section: Surgical Techniquesmentioning

confidence: 99%

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Advances in small bowel transplantation

Gürkan

2017

Turk J Surg

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135Small bowel transplantation is a life-saving surgery for patients with intestinal failure. The biggest problem in intestinal transplantation is graft rejection. Graft rejection is the main reason for morbidity and mortality. Rejection has a negative effect on the survival of the graft. While 50%-75% of small bowel transplantation patients experience acute rejection, chronic rejection occurs in approximately 15% of patients. Immune monitoring is crucial after small bowel transplantation. Unlike other types of transplantation, there are no non-invasive or reliable markers to predict rejection in small bowel transplantation. The diagnosis of AR is confirmed by clinical symptoms, endoscopic appearance, and pathological specimens taken by endoscopy. Thus, histopathological examinations obtained by protocol biopsies remain as the gold standard for intestinal graft monitoring; however, biopsies have some complications, especially in small grafts. In addition to the high complication rate, biopsies are non-diagnostic; thus, multiple biopsies should be performed to exclude rejection. Therefore, auxiliary assays, such as measurements of citrulline and calprotectin in the blood, cytofluorographic examination of peripheral blood immune cells, cytokine profiling, and distinct gene-set-change measurements, are increasingly being used in small bowel transplantation. Developments in the understanding of genes seem to be promising that limited gene sets, taken from blood or from intestinal biopsies, will enhance pathological diagnosis. Bone marrow mesenchymal stem cell transplantation with SBT and tissue engineering are also promising procedures.

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Section: Surgical Techniquesmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

Advances in small bowel transplantation

Gürkan

2017

Turk J Surg

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“…Loss of domain, referring to lack of intraperitoneal space for the transplant intestine after removal of native intestine, is a relatively unique problem in intestine transplant recipients. Loss of domain has been dealt with in a number of innovative ways in recent years by different centers including transplantation of the abdominal wall, expansion of skin flaps with tissue expanders, staged closure of the abdominal wall, reconstruction of the abdominal wall with acellular dermal matrix and transplantation of vascularized or nonvascularized rectus fascia along with the intestine allograft (27)(28)(29)(30)(31)(32).…”

Section: Techniquesmentioning

confidence: 99%

The Current State of Intestine Transplantation: Indications, Techniques, Outcomes and Challenges

Sudan

2014

American Journal of Transplantation

111

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Intestine transplantation is the least common form of organ transplantation in the United States and often deemed one of the most difficult. Patient and graft survival have historically trailed well behind other organ transplants. Over the past 5-10 years registry reports and single center series have demonstrated improvements to patient survival after intestinal transplantation that now match patient survival for those without life-threatening complications on parenteral nutrition. For various reasons including improvements in medical care of patients with intestinal failure and difficulty accessing transplant care, the actual number of intestine transplants has declined by 25% over the past 6 years. In light of the small numbers of intestine transplants, many physicians and the lay public are often unaware that this is a therapeutic option. The aim of this review is to describe the current indications, outcomes and advances in the field of intestine transplantation and to explore concerns over future access to this important and life-saving therapy.

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“…Staged closure of the abdomen has been described by the Birmingham (United Kingdom) group[13], reporting on 23 combined liver and bowel transplants closed using a Silastic ® sheet together with a vacuum occlusive dressing.…”

Section: Introductionmentioning

confidence: 99%

Role of “reduced-size” liver/bowel grafts in the “abdominal wall transplantation” era

Lauro¹,

Vaidya²

2017

WJGS

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The evolution of multi-visceral and isolated intestinal transplant techniques over the last 3 decades has highlighted the technical challenges related to the closure of the abdomen at the end of the procedure. Two key factors that contribute to this challenge include: (1) Volume/edema of donor graft; and (2) loss of abdominal domain in the recipient. Not being able to close the abdominal wall leads to a variety of complications and morbidity that range from complex ventral hernias to bowel perforation. At the end of the 90’s this challenge was overcome by graft reduction during the donor operation or bench table procedure (especially reducing liver and small intestine), as well as techniques to increase the volume of abdominal cavity by pre-operative expansion devices. Recent reports from a few groups have demonstrated the ability of transplanting a full-thickness, vascularized abdominal wall from the same donor. Thus, a spectrum of techniques have co-evolved with multi-visceral and intestinal transplantation, ranging from graft reduction to enlarging the volume of the abdominal cavity. None of these techniques are free from complications, however in large-volume centers the combinations of both (graft reduction and abdominal widening, sometimes used in the same patient) could decrease the adverse events related to recipient’s closure, allowing a faster recovery. The quest for a solution to this unique challenge has led to the proposal and implementation of innovative solutions to enlarge the abdominal cavity.

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Staged abdominal closure after small bowel or multivisceral transplantation

Cited by 38 publications

References 29 publications

Advances in small bowel transplantation

Advances in small bowel transplantation

The Current State of Intestine Transplantation: Indications, Techniques, Outcomes and Challenges

Role of “reduced-size” liver/bowel grafts in the “abdominal wall transplantation” era

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