Incisional hernia after liver transplantation: mesh-based repair and what else?
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ORIGINAL ARTICLE
Incisional hernia after liver transplantation: mesh‑based repair and what else? Aristotelis Perrakis1,2 · Dagmar Knüttel2 · Mirhasan Rahimli1 · Mihailo Andric1 · Roland S. Croner1 · Nikolaos Vassos2,3 Received: 14 May 2020 / Accepted: 25 August 2020 © The Author(s) 2020
Abstract Purpose Incisional hernia (IH) is not uncommon after liver transplantation (LT). We investigated the long-term outcome of mesh-based hernia repair using an inlay-onlay technique. Methods Our analysis was based on a prospective collected database of all LT recipients from our hospital over a period of 15 years. We analyzed clinical data including the period between LT and hernia development, the size and localization of the hernia, the length of in-hospital stay, immunosuppression, and postoperative morbidity, as well as follow-up data. The median follow-up period was 120 (range 12–200) months. Results Among a total of 220 patients who underwent a collective 239 LTs, 29 (13%) were found to have an IH after a median period of 27.5 months (range 3–96 months). There were 12 (41%) men and 17 (59%) women, with a median age of 51 years. The median size of the IH was 13 cm (range 2–30 cm) and the median in-hospital stay was 6 days. Mild postoperative complications developed in seven patients, including two onlay mesh infections. One patient (3.4%) suffered recurrence. Conclusion Mesh-based hernia repair using the inlay/onlay technique represents an effective and safe method for patients with an IH after LT, without additional risk from continuous immunosuppression. Keywords Incisional hernia · Mesh · Liver transplantation
Introduction Incisional hernia (IH) is a common complication after major surgery, with a reported incidence between 5 and 25% [1–5]. Risk factors for an IH after major surgery include obesity, wound infection in the immediate postoperative setting, male gender, and diabetes mellitus [6–15]. Further predisposing factors are collagen disorders, age, rapid weight loss, multiple pregnancies, chronic pulmonary disease, trauma, iatrogenic causes, and congenital disorders [12–20]. Clinical examination and ultrasonography of the abdomen are * Aristotelis Perrakis [email protected] 1
Department of Surgery, University Hospital of Magdeburg, University of Magdeburg, Leipzigerstr. 44, 39120 Magdeburg, Germany
2
Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
3
Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
the most sensitive diagnostic tools for an IH. After its diagnosis, surgical treatment is generally indicated because of the risk of serious complications, such as incarceration and strangulation of the protruding structures. In the posttransplant setting after orthotopic liver transplantation (LT) there are specific parameters, such as ascites and the continuous administration of immunosuppression, especially corticoids, which represent additio
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