Abstract
BackgroundRepair of incisional hernias following orthotopic liver transplantation (OLT) is a surgical challenge due to concurrent midline and transverse abdominal wall defects in the context of lifelong immunosuppression. The peritoneal flap hernioplasty addresses this problem by using flaps of the hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space, exploiting the retro-rectus space medially and the avascular plane between the internal and external oblique muscles laterally. We report our short and long-term results of 26 consecutive liver transplant cases with incisional hernias undergoing repair with the peritoneal flap technique.MethodsPost-OLT patients undergoing elective peritoneal flap hernioplasty for incisional hernias from Jan 1, 2010–Nov 1, 2017 were identified from the Lothian Surgical Audit system (LSA), a prospectively-maintained computer database of all surgical procedures in the Edinburgh region of south-east Scotland. Patient demographics and clinical data were obtained from the hospital case-notes. Follow-up data were obtained in Feb 2020.ResultsA total of 517 liver transplantations were performed during the inclusion period. Twenty-six of these (18 males, 69%) developed an incisional hernia and underwent a peritoneal flap repair. Median mesh size (Optilene Elastic, 48 g/m2, BBraun) was 900 cm2 (range 225–1500 cm2). The median time to repair following OLT was 33 months (range 12–70 months). Median follow-up was 54 months (range 24–115 months) and median postoperative stay was 5 days (range 3–11 days). Altogether, three patients (12%) presented with postoperative complications: 1 with hematoma (4%) and two with chronic pain (8%). No episodes of infection or symptomatic seroma were recorded. No recurrence was recorded within the follow-up period.ConclusionRepair of incisional hernias in patients following liver transplantation with the Peritoneal Flap Hernioplasty is a safe procedure associated with few complications and a very low recurrence rate. We propose this technique for the reconstruction of incisional hernias following liver transplantation.
Highlights
Incisional hernias are reported in 5–20% of cases following liver transplantation [1,2,3]
26 patients developed an incisional hernia within the review period (5%)
30% of the abdominal wall repairs in our institution are performed for transverse hernias, 19% of these in liver transplant recipients [13]
Summary
Incisional hernias are reported in 5–20% of cases following liver transplantation [1,2,3]. The present study aims to describe the peritoneal flap technique for the repair of incisional hernias after liver transplantation and to present the short and long-term results of this technique in these patients. The data demonstrates that the peritoneal flap technique is a safe procedure that can be used for the repair of incisional hernias in high-risk liver transplant recipients with few complications and a very low recurrence rate. Due to the complex nature of the incision, the peritoneal flap approach with its ability to bridge both transverse [13] and midline [11] abdominal wall defects constitute an attractive alternative to component separation in liver transplant patients. Patients were regularly followed up in the liver transplant clinic Those with symptoms or signs of complications related to the abdominal wall repair were referred on for assessment by a hernia specialist. Imaging (CT or ultrasound) was performed to document the presence or absence of short and long-term complications and to confirm or refute the presence of recurrence
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