Renal paratransplant hernia revealed: a review of the literature

Abstract

RPH is a relatively uncommon but potentially fatal complication after renal transplantation, and its non-specific symptoms may lead to misdiagnosis. Physician awareness, prompt diagnosis, and early surgical intervention are critical. In addition, meticulous surgical technique during transplantation may help avoid this complication.

Incisional Hernia in Kidney Transplant Recipients: A Single Center Experience

“…Yine çalışmamızda insizyonel herni gelişen hastalar içerisinde akut rejeksiyon nedeniyle bolus streoid tedavisi alan ve immunsüpresif tedavi için m-TOR inhibitörü kullanılan hasta yoktu. İnsizyonel herni tanısı için fizik muayenenin yanı sıra ultrasonografi ve tüm batın bilgisayarlı tomografisi gibi radyolojik görüntüleme yöntemleri kullanılmaktadır [9]. Çalışmamızda da fizik muayenesinde insizyonel herni saptanan hastalara herniye ait defektin yapısını ve büyüklüğünü belirlemek için tüm batın bilgisayarlı tomografisi çekildi.…”

Abdominal wall complications after kidney transplantation: A clinical review

“…Risk factors for RPH are similar to those for IH and include obesity, a large‐for‐size graft and the formation of lymphocele 101–104 . Renal paratransplant hernia develops more frequently in men with a mean age of 41.2 years (range 22–64 years) and in most cases is an early postoperative complication, with a time from transplantation to presentation varying from three days to 18 months, with a median of 30 days 102,103 . Given its rarity, a timely diagnosis is mandatory to avoid potentially lethal complications, and RPH should be suspected in every transplant recipient displaying signs and symptoms of small bowel obstruction.…”

“…Among the 12 recipients with RPH, four (33.3%) required bowel resection for intestinal necrosis 101–104 . A side‐to‐side two‐layer hand‐sewn anastomosis may be preferable 102 due to a potentially higher risk of postoperative bleeding after stapler use 102,105 . Closure of the peritoneal defect could be performed with interrupted absorbable sutures or, in the event of a larger defect, with a mesh 102 .…”

“…Once the diagnosis is established, early surgical intervention is warranted with immediate laparotomy. Surgical treatment of RPH may be challenging, because the peritoneal defect is usually small and strangulation is more likely, and because the reported mortality associated with bowel necrosis in transplant patients may be as high as 80% 102 . The surgical approach should take into account the possible injury to the graft during small bowel manipulation and the need for intestinal resection if bowel necrosis is evident.…”

“…Renal paratransplant hernia (RPH) is an uncommon type of IH, caused by the entrapment of a bowel loop through a defect in the peritoneum covering the transplant kidney, and is a potentially life-threatening complication. 101,102 A total of 12 cases have been reported in the literature, 102,103 and it should be considered an iatrogenic surgical complication; in almost all cases, a defect of the peritoneum is found intraoperatively. It has been postulated that RPH could be a consequence of inappropriate maneuvers while sliding the peritoneum to prepare the iliac vessels for anastomosis and for creating space for the kidney graft.…”