Giulio Giambartolomei, MD, Samuel Szomstein, MD, FACS, Rama Ganga, MD, Raul J Rosenthal, MD, FACS, Emanuele Lo Menzo, MD, PhD, FACS. Cleveland Clinic Florida
Background: The incidence of incisional hernias after liver transplants is reported to vary from 4% to 20%, and considerably affects patients’ quality of life. Obesity and immunosuppression can increase both the incidence and the recurrence of incisional hernias in this population. We present our short-term experience with hernia repair in this patient population.
Methods: We retrospectively reviewed all the patients who underwent incisional hernia repair from November 2012 to May 2017 at Cleveland Clinic Florida. We then identified those who previously underwent an orthotropic liver transplant and we reported demographics, technique, and outcomes.
Results: Out of 280 patients who underwent incisional hernia repair we identified 4 patients (1.4%) who previously received a liver transplant. There were 3 males and one female. The average age was 58.25 (49-66), mean BMI was 32.16 Kg/m2(30.27-33.75). Mean interval from transplant to hernia repair was 969 days (370-2151). Two patients had a previous attempt of hernia repair, one with mesh. One patient did not have any immunosuppression due to HIV infection, whereas the other were on cyclosporine, tacrolimus and/or mycophenolate mofetil. There were two laparoscopic and two open cases, mean operative time was 169.25 minutes (111-311), mean blood loss was 85 ml (20-200). Mesh used were biological porcine dermis in one case, polypropylene with absorbable hydrogel barrier in three cases. Mean mesh length and width were 27 cm (20-33) and 28.25 cm (25-33) respectively. One patient underwent a component separation, though none of the patients had the fascial defect closed. There were no intra-operative complications. Three patients were readmitted for hyperkalemia, abdominal pain, and seroma respectively. Neither recurrences nor reoperations were reported. Mean follow-up was 75.5 days (17-136)
Conclusion: Post liver transplant incisional hernia repair is feasible either laparoscopic or in an open fashion. Because of the size and location of the defect, fascial closure is unlikely achievable. The use of standard techniques and materials give a similar result of the non-transplant population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87092
Program Number: P721
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster