Laparoscopic Approach for Incisional Hernias in Patients After Organ Transplantation Or With Liver Insufficiency

Marty Zdichavsky, MD, Dörte Wichmann, MD, Maria Witte, MD, Maximillian Von Feilitzsch, MD, Tobias Meile, MD, Alfred Königsrainer, MD. Department of General, Visceral and Transplant Surgery

Objective
Incisional hernia in patients with liver insufficiency or after organ transplantation has to be regarded a frequent complication. Immunosuppressive regimen, ascites and decrease of protein synthesis are causal for appearance of incisional hernias. Limited experience exist for this patient population, especially for the laparoscopic approach (= IPOM, intraperitoneal onlay mesh). To address this issue the aim of this study was to compare the recurrence and complication rate of open and laparoscopic incisional hernia techniques.
Methods
Data were retrospectively analyzed. Inclusion criteria were patients that underwent incisional hernia repair electively after organ transplantation, with liver insufficiency (Child B or C), or chronic inflammatory bowl disease. Patient’s characteristics, operative data, recurrence rate and complications were evaluated.
Results
79 patients (f:32, m:47) with a mean age of 62.4 years were included: 57 patients after organ transplantation, 16 with liver cirrhosis and 6 with inflammatory bowl disease. 25 patients were treated laparoscopically with the IPOM technique, 54 with conventional hernia repair. In 11.9% no mesh prosthesis was used. Size of hernia defect was significant larger in the IPOM group (›8cm). Complications were 3 postoperative hemorrhages, 1 early recurrence with incarceration, 1 infected seroma and 1 unspecific infection. All complications occurred within the open group. Overall recurrence rate was 19%, however one patient with chronic inflammatory bowl disease developed 3 recurrences. 12 recurrences occurred after open hernia repair (22.2%) and 3 after IPOM procedure (12.0%). Recurrence rate was increased in patients with ascites and hernia repair without mesh prosthesis.
Conclusions
IPOM technique for laparoscopic hernia repair seems encouraging concerning a very low complication rate. Recurrence rate was moderate regarding the significant larger diameter of hernias that were treated laparoscopically.