Arch Plast Surg.  2019 Sep;46(5):462-469. 10.5999/aps.2018.01361.

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

• Black CK
• Zolper EG
• Walters ET
• Wang J
• Martinez J
• Tran A
• Naz I
• Kotha V
• Kim PJ
• Sher SR
• Evans KK

• KMID: 2464623
• DOI: http://doi.org/10.5999/aps.2018.01361

Abstract

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.

Keyword

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

MeSH Terms

Abdominal Wall*
Abscess
Body Mass Index
Comorbidity
Female
Follow-Up Studies
Hematoma
Hernia
Hernia, Abdominal
Herniorrhaphy
Humans
Hypertension
Immunosuppression
Incisional Hernia
Kidney Transplantation
Kidney*
Liver Transplantation
Liver*
Male
Organ Transplantation
Recurrence
Retrospective Studies
Seroma
Surgical Mesh
Tobacco Use
Transplants