Utility of a modified components separation for abdominal wall reconstruction in the liver and kidney transplant population

Background Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence.

Methods This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay.

Results The mean age of patients was 61.0±8.3 years old, with a mean body mass index of 28.4±4.8 kg/m², 15 males (78.9%), and four females (21.1%). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2%), diabetes (9 patients, 47.4%), and tobacco use (8 patients, 42.1%). Complications occurred in six patients (31.6%) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of 28.7±22.8 months. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days.

Conclusions This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.

Keywords

Transplants - Surgical mesh - Incisional hernia - Immunosuppression - Abdominal wall

This article was presented at the American Society of Plastic Surgery, on September 28–October 1, 2018, in Chicago, IL, USA.

We would like to acknowledge Eshetu Tefera, the department’s biostatistician, for his help with the statistics. We would also like to thank Marielle Mahan, a Georgetown University medical student, for helping with the medical illustrations.

Publication History

Received: 15 November 2018

Accepted: 01 September 2019

Article published online:
03 April 2022

• REFERENCES

• 1 Smith CT, Katz MG, Foley D. et al. Incidence and risk factors of incisional hernia formation following abdominal organ transplantation. Surg Endosc 2015; 29: 398-404
• 2 Humar A, Ramcharan T, Denny R. et al. Are wound complications after a kidney transplant more common with modern immunosuppression?. Transplantation 2001; 72: 1920-3
• 3 Vardanian AJ, Farmer DG, Ghobrial RM. et al. Incisional hernia after liver transplantation. J Am Coll Surg 2006; 203: 421-5
• 4 Kahn J, Muller H, Iberer F. et al. Incisional hernia following liver transplantation: incidence and predisposing factors. Clin Transplant 2007; 21: 423-6
• 5 Ayvazoglu Soy EH, Kirnap M, Yildirim S. et al. Incisional hernia after liver transplant. Exp Clin Transplant 2017; 15 (Suppl 1) 185-9
• 6 Ooms LS, Verhelst J, Jeekel J. et al. Incidence, risk factors, and treatment of incisional hernia after kidney transplantation: an analysis of 1,564 consecutive patients. Surgery 2016; 159: 1407-11
• 7 Piardi T, Audet M, Panaro F. et al. Incisional hernia repair after liver transplantation: role of the mesh. Transplant Proc 2010; 42: 1244-7
• 8 Brewer MB, Rada EM, Milburn ML. et al. Human acellular dermal matrix for ventral hernia repair reduces morbidity in transplant patients. Hernia 2011; 15: 141-5
• 9 Darehzereshki A, Goldfarb M, Zehetner J. et al. Biologic versus nonbiologic mesh in ventral hernia repair: a systematic review and meta-analysis. World J Surg 2014; 38: 40-50
• 10 Coccolini F, Catena F, Bertuzzo VR. et al. Abdominal wall defect repair with biological prosthesis in transplanted patients: single center retrospective analysis and review of the literature. Updates Surg 2013; 65: 191-6
• 11 Santangelo ML, Carlomagno N, Spiezia S. et al. Use of biological prostheses in transplant patients with incisional hernias: preliminary experience. Ann Ital Chir 2013; 84: 471-5
• 12 Scheuerlein H, Thiessen A, Schug-Pass C. et al. What do we know about component separation techniques for abdominal wall hernia repair?. Front Surg 2018; 5: 24
• 13 Ibrahim AM, Vargas CR, Colakoglu S. et al. Properties of meshes used in hernia repair: a comprehensive review of synthetic and biologic meshes. J Reconstr Microsurg 2015; 31: 83-94
• 14 Li EN, Silverman RP, Goldberg NH. Incisional hernia repair in renal transplantation patients. Hernia 2005; 9: 231-7
• 15 Kwon S, Thompson R, Dellinger P. et al. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg 2013; 257: 8-14
• 16 Buranasin P, Mizutani K, Iwasaki K. et al. High glucose-induced oxidative stress impairs proliferation and migration of human gingival fibroblasts. PLoS One 2018; 13: e0201855
• 17 Wong SL, Demers M, Martinod K. et al. Diabetes primes neutrophils to undergo NETosis, which impairs wound healing. Nat Med 2015; 21: 815-9