Incisional Hernia and Its Repair With Polypropylene Mesh in Renal Transplant Recipients

Abstract

In the majority of cases incisional hernia develops in the first 3 months after transplant surgery. The incidence is significantly higher in white patients and after cadaveric donor transplantation. Surgical complications of transplant surgery are important predisposing factors for incisional hernia after kidney transplantation. Surgical repair using polypropylene mesh is safe and effective in this group of patients.

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“…26 Incisional hernias mostly develop in the first 3 months after kidney transplant. 21 The major predisposing surgical factors included incision type, emergency surgery, drains placed through the wound, implantation of a foreign body, technical closure faults, or inadequate suture material. 21 We did not find drain placement to be a predictor of incisional hernia.…”

“…19,20,27 Delayed graft function is thus associated with lower graft survival, longer hospital stay, higher costs, and increased psychologic and significant medical sequelae. [17][18][19][20][21][24][25][26][27][28][29][30] In patients with DGF, hemodialysis itself is an additional oxidative stress. The need for even 1 dialysis session posttransplant creates a milieu that affects B and T cells, which can lead to impaired wound healing and/or wound breakdown.…”

“…Surgical site infection is also considered to be an important risk factor contributing to the development of incisional hernias in nontransplanted patients. 8,21,29 The negative effects of immunosuppressive therapy after kidney transplant on the patient's immune system further contribute to the high incidence of SSI and therefore the increased incidence of incisional hernias due to disturbed and delayed wound healing in the early postoperative period after kidney transplant. 3,4 Surgical site infections, the second most common cause of nosocomial infection after urinary tract infections, cause approximately 17% of all hospitalacquired infections and lead to increased costs and worse patient outcomes in hospital inpatients.…”

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“…Decreased wound length from 15 to 20 cm in the open approach to 5 to 6 cm in laparoscopy could be useful to improve the current 3% to 4% incisional hernia and 16% to 21% wound infection rates for this procedure. 16,17 To reduce surgical aggressiveness, Øyen and associates used a minimally invasive technique for kidney autotransplant, where laparoscopy and open surgery were combined to perform a laparoscopic nephrectomy and then a vascular anastomosis using a 7-cm pararectal incision. 18 However, a 7-cm incision is a too short to securely perform a conventional kidney transplant; therefore, the combination with a laparoscopic approach is the natural evolution toward a less invasive technique.…”

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“…Prognosticators include diabetes, a high body mass index (BMI), poor nutrition status, delayed graft function (DGF), longer operative times, advanced age, poor surgical technique, and nicotine consumption. 1,[5][6][7][8][9][10][11][12][13] The immunosuppressant regimen plays an integral role in the development of wound issues. Sirolimus, an mTOR inhibitor, has a well-known association with wound complications.…”