Is the incision type important for the development of hernia in liver transplant patients?

Zarbaliyev, Elbrus; Sevmiş, Murat; Kilercik, Hakan; Çelik, Sebahattin; Aktaş, Sema; Caglikulekci, Mehmet; Sevmiş, Ş.

doi:10.1111/ctr.14497

Cited by 2 publications

(4 citation statements)

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“…10,[31][32][33] These approaches can lead to higher rates of recurrences compared with traditional laparotomy incision at the midline. 7,34 We hypothesize that the senior author's technique 18 is uniquely suited to address large defects of the post-OLT population. The core principle of the technique is to renew myofascial continuity via component separation and use multipoint suture fixation to supplement the restoration.…”

Section: Discussionmentioning

confidence: 99%

“…The traditional chevron and Mercedes-Benz incisions are a combination of midline, subcostal, and flank components that can lead to disruption of the myofascial domain of the abdomen and weakening of the rectus abdominis 10,31–33 . These approaches can lead to higher rates of recurrences compared with traditional laparotomy incision at the midline 7,34 . We hypothesize that the senior author's technique 18 is uniquely suited to address large defects of the post-OLT population.…”

Section: Discussionmentioning

confidence: 99%

“…The orthotopic liver transplant (OLT) patient population, in particular, is at up to a 43% risk for ventral hernia 1–6 . The orientation of the larger chevron incisions used with liver transplants can lead to greater myofascial weakening and further compromise the ventral abdominal wall compared with other post laparotomy patients 7 . In the last 20 years, the number of OLTs performed and the posttransplant survival of patients have increased steadily, 8,9 leading to an older population with an increased risk over their life span of abdominal wall defects 1–3,10,11 .…”

mentioning

confidence: 99%

“…[1][2][3][4][5][6] The orientation of the larger chevron incisions used with liver transplants can lead to greater myofascial weakening and further compromise the ventral abdominal wall compared with other post laparotomy patients. 7 In the last 20 years, the number of OLTs performed and the posttransplant survival of patients have increased steadily, 8,9 leading to an older population with an increased risk over their life span of abdominal wall defects. [1][2][3]10,11 Orthostatic liver transplant ventral hernias are further complicated by patient susceptibility to obesity, pulmonary disease, local and remote infections, and malnutrition that leads to a notable challenge for plastic, transplant, and general surgeons.…”

mentioning

confidence: 99%

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Outcomes of Ventral Hernia Repair After Orthotopic Liver Transplant Using Component Separation and Onlay Biologic Mesh

Soto¹,

Zoog²,

Nolte³

et al. 2023

Ann Plast Surg

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IntroductionThe management of ventral hernias (VHs) after orthotopic liver transplant (OLT) can be uniquely challenging because of immunosuppression coupled with large laparotomy size that can compromise the quality of the abdominal wall. The component separation with multipoint suture onlay acellular dermis fixation technique has proven to be effective in high-risk abdominal wall reconstructions. The goal of this study was to elucidate the factors that affect safety and efficacy of VH repair in post-OLT patients.MethodsA retrospective review of 345 patients who underwent repair of VH with compartment separation and onlay acellular dermal matrix reinforcement from a single surgeon from 2012 to 2020 was conducted. Of these, 27 patients were identified with a history of OLT and were stratified based on whether the defect was a initial or recurrent hernia repair. The majority of patients had a standard chevron incision (70%). Data abstraction was performed for preoperative risk factors, hernia characteristics, surgical site complications, and postoperative course including hernia recurrence.ResultsA majority of cases in the study period were initial hernia repairs (59%) with no significant differences in the patient demographics and size of VH defects (190 ± 112.69 cm2). Comorbidities were similar between the groups with the exception of a significantly higher baseline creatinine levels and higher history of smoking in the recurrent hernia repair group (P < 0.05). Of the 27 cases, there were no demonstrable hernia recurrences noted and an overall 11% complication rate. Univariate analysis noted a statistically significant difference in surgical site complication rate (P = 0.017), with the initial hernia repair group having the lowest rate of surgical site complications.ConclusionsIn complex post-OLT patients with large VH, modified component separation with onlay acellular mesh was shown to have acceptable medium-term results. Further studies investigating the factors leading to postoperative complications are necessary to reduce recurrence in this evolving patient population.

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