Abstract
About 5%-11% of all abdominal surgery results in incisional hernia. This rate can be even higher among high-risk populations such as transplant patients. Lifetime incidence of incisional hernia following liver transplant is as high as 43% in recent studies. The transplant population is at higher risk for incisional hernia precisely because of their immunosuppressive therapy. Thus, it is imperative to understand the risk factors for incisional hernia in this unique patient population. This article focuses on understanding preoperative, intraoperative, and postoperative risk factors for failure of hernia repair in the transplant population in addition to discussing risk stratification for incisional hernia in this population. Furthermore, we discuss the utility of panniculectomy in abdominal organ transplantation. Additionally, we discuss the value of mesh placement in abdominal wall closure. Finally, we review the concept of vascularized composite allograft as a method for achieving abdominal wall closure for patients who have failed more traditional repairs and who are left with inadequate tissue for successful repair.
Highlights
5%-11% of all abdominal surgery incisions result in incisional hernia, but this rate can exceed 30% in complex wounds among high-risk patients such as those undergoing solid organ www.parjournal.net
The stakes are high because wound infection, dehiscence, or incisional hernia have the potential to compromise graft function and viability and because efforts to heal are obtunded by the presence of often powerful immunosuppressive medications
Simultaneous panniculectomy appears to be performed without a significant increase in wound healing morbidity even though these single-stage patients must face the challenge of healing after induction and maintenance of immunosuppression[15]
Summary
5%-11% of all abdominal surgery incisions result in incisional hernia, but this rate can exceed 30% in complex wounds among high-risk patients such as those undergoing solid organ www.parjournal.net. Common to these risk factors - obesity, ascites, and COPD - is increased intra-abdominal pressure, which puts mechanical stress on the fascial closure and weakens the abdominal wall, making patients more prone to wound necrosis, breakdown, and hernia[2,4].
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