Techniques for Closing the Abdominal Wall in Intestinal and Multivisceral Transplantation: A Systematic Review

Abstract

Short bowel syndrome is the most common etiology of intestinal failure, resulting from either resections of different intestinal segments or a congenital condition. Due to the absence or considerable reduction of intestinal loops in the abdominal cavity, patients with short bowel syndrome present with atrophy and muscle retraction of the abdominal wall, which leads to loss of abdominal domain and elasticity. This complication is an aggravating factor of intestinal transplantation since it can prevent the primary closure of the abdominal wall. A vast array of surgical techniques to overcome the challenges of the complexity of the abdominal wall have been described in the literature. The aim of our study was to review the modalities of abdominal wall closure in intestinal/multivisceral transplantation. Our study consisted of a systematic review following the methodological instructions described in the PRISMA guidelines. Duplicate studies and studies that did not meet the criteria for the systematic review were excluded, especially those without relevance and an explicit relationship with the investigated theme. After this step, 63 articles were included in our study. The results obtained with these techniques have been encouraging, but a high incidence of wound complications in some reports has raised concerns. There is no consensus among transplantation centers regarding which technique would be ideal and with higher success rates and lower rates of complications.

Multilevel Analysis of the Neovascularization and Integration Process of a Nonvascularized Rectus Fascia Transplantation

“…There is no consensus about how long fascia can safely be preserved. 27 , 28 Several cold ischemia times have been reported up to 21 days. 4 , 12 Possibly, the graft could even be cryopreserved.…”

Contemporary Abdominal Wall Reconstruction: Emerging Techniques and Trends

“…The highest rung on the reconstructive ladder for abdominal wall reconstruction is abdominal wall vascularized composite allotransplantation (AW-VCA) [85]. This is performed in the context of small bowel or multivisceral transplantation due to the severe abdominal fibrosis and loss of abdominal domain often encountered in these patients [86,87]. The cases of AW-VCA described in the current literature are non-innervated [88].…”

Innovative surgical techniques in the intestine and multivisceral transplant

“…AWT involves grafting partial or full-thickness abdominal wall tissue, with the same donor used for intestinal transplant. Immunological matching is not a concern, and AWT does not necessitate www.co-transplantation.com additional immunosuppression [37,[38][39][40][41][42][43]. Patients who undergo the discussed transplants usually have long surgical histories or diseases that severely damage the abdominal walls, severely complicating the possibility of primary closure [36].…”

“…Generally, the most commonly used techniques are meshes, both absorbable and nonabsorbable, acellular dermal matrix, bioengineered skin equivalents, and rectus fascia as a nonvascularized allograft to replace the fascia, each with its indications and limitations [47,[50][51][52]. For more complex cases, such as when all components of the abdominal wall are affected, an increasing option is the AWT, in which partial or full-thickness abdominal wall grafts are used to close the cavity [37,[38][39][40][41][42].…”