Post liver transplant incisional hernia management
Ebru H. Ayvazoglu Soy1, Mahir Kirnap1, Gokhan Moray1, Mehmet A. Haberal1.
1Transplantation, Baskent University, Ankara, Turkey
Aim: The development of incisional hernia (IH) following liver transplant (LT) comprises a potential complication. Here, we aimed to evaluate our postLT IH management.
Materials and Methods: At our center, we use Mercedes incision in adults and bilateral subcostal incision in infants. We base closure of the abdomen according to perfusion of graft. All patients received methylprednisolone, tacrolimus and mycophenolate mofetil based immunosuppression.
Results: Between December 1988 and December 2019 we performed 649 LT. To have a reasonable period, we evaluated 452 LT (207 pediatric, 245 adult). IH was diagnosed in 29 LT (6.4%) (7 pediatrics and 22 adults). Most of them were males (77%) with Child C cirrhosis (62%), moderate/severe ascites (81%) and serum albumin<3.5g/L (86%). IH were occured more in LT recipients with wound infection, body mass index of ≥ 30 kg/m² and repeated surgery. We repaired IH in 22 adult LT (age range, 31-62 y); 5 primary repair and 17 with prolene mesh graft (3 sublay, 14 onlay). 3 seromas, 1 subcutaneous hemorrhage were seen during the early period of IH repair (18%). We had no other complications or recurrence during follow-up (range, 51-181 mo). Of 207 pediatric LT; 58 patients had body weight < 10 kg and GBWR > 4%. 18 pediatric LT had large-for-size grafts so we closed skin in 11 and abdomen with Bogota bag in 7. All abdomens with Bogota bags were closed in 2 weeks. IH repair was made in 7 pediatric patients after the first year of LT (range 12-15 mo,4-6 kg); 5 primary and 2 onlay mesh repair. None of these patients had any complications or recurrence during follow up (range, 55-103 mo)
Conclusion: Even though the management of liver transplant complicated with incisional hernia is considered to be challenging, it can be handled successfully.
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