V-053 USE OF ABDOMINAL FASCIA TRANSPLANTATION FOR COMPLEX GIANT INCISIONAL HERNIA AFTER LIVER TRANSPLANT

Abstract

Abstract Incisional hernias are a well-known complicationafter liver transplantation, with an incidence of up to 15%. Conventional closure techniques such as synthetic or biological meshes do not have proper results, probably due to a variety of factors including tension in a definitive wall closure and the use of immunosuppressive drugs that can cause necrosis and wound infection. Alternative techniques such as a complete abdominal fascia transplantation can sometimes be needed. We present the case of a 57-year-old man with a history of liver transplantation due to HCV Cirrhosis, Portal Thrombosis and Pulmonary Hypertension. The patient developed a hernia of the Mercedes scar with a large fascial defect that caused him pain and obstructive symptoms. Surgical intervention was performed for hernia repair. During surgery, a large aponeurotic defect was identified with a ring of 25×15cm associated with an adhesion syndrome within the hernial sac. During surgery, the hernial sac was released, followed by release of the anterior aponeurosis and peritoneal closure. An abdominal wall transplant was performed from a 56-year-old donor after the graft had been preserved for 10 days in Celsior® at 4°. The fascial graft was placed to cover the abdominal wall defect and sutured to the edges of the recipient's fascia, using 4 interrupted 2-0 polypropylene non absorbable stitches. This patient's loss of domain of the abdominal cavity, associated with the existing vascular complications, were more than sufficient reasons to choose this technique. The patient's postoperative course was uneventful, but developed bulging during follow-up, without any additional complications.