Laparoscopic Repair of Incisional Hernias Following Renal Transplantation

Introduction: While laparoscopic mesh repair is gaining popularity as the standard technique for incisional hernia repairs, it has not so far been reported in renal transplant recipients. Technical challenges, including proximity to the allograft and the absence of a fascial margin make laparoscopic repair difficult. However, the lower recurrence rates, fewer complications, and shorted hospital stays that a laparoscopic approach offers compared to an open repair is ideal in this immunosuppressed population. We describe the technique of laparoscopic mesh repair of incisional hernias in renal transplant recipients.
Patients and methods: From May 2005 to Septempber 2008, 14 patients (12 males, 2 females, average age = 51 years) in one institution underwent laparoscopic hernia repair by a single surgeon (primary hernias n=12; recurrent hernias n=2) after retroperitoneal right and left lower quadrant renal transplantation. Operative notes, hospital records and office charts were retrospectively reviewed for operative technique, early or late complications, and recurrence data.
Results: Laparoscopic repair was completed successfully in all patients using (Dualmesh® n=9; Parietex® n=3; Premacor® n=1, and Proceed® n=1) mesh. No perioperative complications occurred. At mean time of follow-up of 26 months (1-41 months), there were no mortalities. One patient formed a postoperative seroma that was percutaneously aspirated. The same patient subsequently developed mesh stretch without migration, requiring replacement of a Dualmesh® with a Parietex® mesh 14 months after initial repair. No other hernia recurrences occurred.
Conclusion: Laparoscopic mesh repair of incisional hernias following lower quadrant renal transplantation is safe and feasible. Recognition of the anatomical relations of the renal allograft is of paramount importance. Laparoscopic repair should be the preferred procedure in transplant recipients, as it can provide similar outcomes to the non-transplant population.

Session: Poster

Program Number: P463

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