Thomas S Auer, MD, James E Waha, MD, Erwin Mathew, MD, Daniela Kniepeiss, MD, MBA, FEBS, Peter Schemmer, MD, MBA, FACS. Department of Surgery, Medical University Graz
Introduction: The challenges in hernia following liver transplantation are the types of incision, surgical site infection due to immunosuppressants and the multimorbidity these patients often present with. Therefore, patients with hernia after solid organ transplantation can be considered grade 2 according to the classification of the ventral hernia working group. The incidence for developing ventral hernia after transplantation has a wide variation according to literature. At our centre in Graz we have an incidence of 26%. Repair using mesh implantation reduces recurrence rates. Polypropylene mesh is prone to chronic contamination in immunosuppressed patients. Biomesh did not fulfill the expectations due to high recurrence rates and inflammatory reactions. P4HB bioabsorbable mesh seems to be a good alternative. It is a knitted monofilament, it degrades gradually via hydrolysis, it is fully resorbed after 18 months, while providing mechanical strength for 12 months, and it enables remodelling by host tissue. This mesh shows good results even in grade 3 morbidity wounds which we showed last year in a poster presentation at SAGES in Houston.
Methods: In 2016 we treated 5 patients with incisional hernia following liver transplantation with P4HB mesh in onlay technique and small bites suture.
Results: The follow-up period was between 10 to 20 months and still ongoing. No mesh had to be explanted, no surgical site infections, no delayed wound healing were observed. One hernia recurrence presented after 12 months with a 2,5 cm herniation along the left subcostal margin. 4 patients remained without complications and discomfort.
Conclusion: Treating incisional hernia of patients after liver transplantation with P4HB mesh in onlay-enforced technique is feasible and safe. Of course, more data is needed. In order to lower the incidence of incisional hernia in this group of patients we are preparing a trial for prophylactic P4HB mesh placement in patients undergoing liver transplantation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87403
Program Number: P006
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster