Strategies for operative management of abdominal wall hernia after solid organ transplant

Abstract

About 5%-11% of all abdominal surgery results in incisional hernia. This rate can be even higher among highrisk populations such as transplant patients. Lifetime incidence of incisional hernia following liver transplant is as high as 43% in recent studies. The transplant population is at higher risk for incisional hernia precisely because of their immunosuppressive therapy. Thus, it is imperative to understand the risk factors for incisional hernia in this unique patient population. This article focuses on understanding preoperative, intraoperative, and postoperative risk factors for failure of hernia repair in the transplant population in addition to discussing risk stratification for incisional hernia in this population. Furthermore, we discuss the utility of panniculectomy in abdominal organ transplantation. Additionally, we discuss the value of mesh placement in abdominal wall closure. Finally, we review the concept of vascularized composite allograft as a method for achieving abdominal wall closure for patients who have failed more traditional repairs and who are left with inadequate tissue for successful repair.

Incidence Rate of Incisional Hernia Post Liver and Kidney Transplant at a Tertiary Center in Riyadh, Saudi Arabia

“…According to Garmpis et al [ 14 ], type of incisions such as the bilateral subcostal incision and the Mercedes incision could play a role in incisional hernia formation among liver transplant recipients. On the scope of that, both subcostal and Mercedes incisions are large incisions, which may be a factor contributing to the incisional hernia incidence among liver transplant patients [ 20 ]. The incidence rate that has been shown among liver transplants in this study was noticed to be similar to the local study done by Hegab et al [ 21 ].…”

“…On the other hand, female gender, history of smoking, obesity, delayed graft function, increased age, and deceased donor were considered as factors for incisional hernia in kidney transplant patients [ 11 , 12 , 24 ]. Additionally, immunosuppressive medications were reported as factors in incisional hernia among organ transplant patients [ 20 ]. The absence of mycophenolate mofetil (MMF) has been reported as a risk associated with incisional hernia [ 11 , 12 ].…”

Outcomes of Ventral Hernia Repair After Orthotopic Liver Transplant Using Component Separation and Onlay Biologic Mesh

“…Most studies published in the subject seem to be smaller case series using a variety of approaches by different surgical teams. 4,12,[21][22][23] We seek to report the outcomes of a single surgeon's experience in repairing post-liver transplant incisional hernias using a particular AWR technique.…”

“…Surgeons must consider comorbidities and risk factors to maximize postrepair outcomes of incisional ventral hernias in post-OLT patients. Recent studies have started documenting the outcomes of abdominal wall repair in the general transplant population 4,9,10,13,14,21–25 . Although the incidence of incisional hernia repair has been well described, less attention has been paid to the management of ventral hernia repairs in the liver transplant population using the open AWR approach.…”

“…Although the incidence of incisional hernia repair has been well described, less attention has been paid to the management of ventral hernia repairs in the liver transplant population using the open AWR approach. Most studies published in the subject seem to be smaller case series using a variety of approaches by different surgical teams 4,12,21–23 . We seek to report the outcomes of a single surgeon's experience in repairing post–liver transplant incisional hernias using a particular AWR technique.…”