Use of Intraperitoneal ePTFE Gore Dual-Mesh Plus in a Giant Incisional Hernia After Kidney Transplantation: A Case Report

Abstract

We evaluated the incidence of and predisposing factors for an incisional hernia after kidney transplantation. Numerous techniques have been used to repair postoperative fascial dehiscences or simple incisional hernias, but no clear treatment exists for giant hernias. Our aim was to obtain (1) a safe procedure to repair a large abdominal defect and reinforce the surrounding, fragile zones and (2) a simple, rapid technique to reduce the operative time. Herein we have described the surgical repair of a giant incisional hernia using intraperitoneal Gore ePTFE dual-mesh plus (Gore-Tex; W. L. Gore, Flagstaff, Ariz, USA) in a 55-year-old man status-post renal transplantation. Total necrosis of distal graft ureter had caused a giant urinoma. The patient was reexplored on day 2 posttransplantation with a primary fascial approximation. Thirty days after transplantation we discovered a large incisional hernia and performed a repair. No drain was used. The patient continued immunosuppressive therapy (cyclosporine, mycophenolate mofetil, prednisolone) and was discharged on postoperative day 4 with no complications. An ultrasonographic follow-up at 1 year revealed the prosthesis to be correctely positioned. Incisional hernia is not rare after renal transplantation but the real incidence is unknown. Immunosuppressive therapy, prolonged pretransplantation dialysis, obesity, and diabetes are probably the major causes of incisional hernias in these patients. Surgical complications of renal transplantation surgery, such as wound hematoma, urinoma, and lymphocele, are the most important predisposing factors for an incisional hernia. The use of intraperitoneal ePTFE dual-mesh is feasible, safe, and easy to repair a large incisional hernia in a kidney transplant patient.

Renal Allograft Compartment Syndrome: Is It Possible to Prevent?

“…Furthermore, there are no guidelines regarding the use of prostheses; in general a biological prosthesis is used (Permacol) when the use of synthetic prostheses is not favorable or is contraindicated, as in the case of a potential source of infection. However, synthetic prostheses are currently used [28] and in the studies reviewed there were differences in the incidence of infection and/or complications. Indeed, we must dispel the subjective opinion entry of the increased incidence of infectious complications by using prosthetic mesh in such immunosuppressed patients.…”

Effectiveness and versatility of biological prosthesis in transplanted patients

“…The rate of IH after OLT is estimated to range from 1.7% to 32.4%[ 9 , 10 ]. In OLT patients several risk factors have been defined, including male sex, elevated body mass index, wound infection, hematoma, ascites, repeat interventions, immunosuppressive drugs, low platelets count, abdominal wall closure technique, diabetes mellitus and smoking history[ 11 , 12 ]. Different techniques are available to repair the IH, including open techniques with primary fascia closure and open or laparoscopic repair with synthetic or biological mesh[ 13 ].…”

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“…[1][2][3] Incisional hernias develop in 10% patients who subsequently develop a wound infection. 1 The risks of fascial dehiscence, wound infection, and incisional hernias are higher in organ recipients than they are in other patients.…”

“…1 Several risk factors have been defined including obesity, wound infection, hematoma, urinoma, lymphocele, repeat interventions, immunosuppression, diabetes mellitus, advanced age, malnutrition, and smoking history. 1,3 The main principle of incisional hernia repair is to restore the anatomic and physiologic integrity of the abdominal wall. 2 Fascial defects with diameter < 6 cm can be repaired primarily, but 30% to 50% defects > 6 cm recur after primary closure.…”

“…Simple, small, and noninfected incisional hernias may be repaired either primarily or with polypropylene mesh with good results. 3 Large cases of fascial dehiscence requiring abdominal reconstruction rarely are discussed in the literature, and no clear treatment method exists for giant incisional hernias in transplant patients. Recent studies have shown that biological prostheses have a greater ability to integrate into tissues, resist bacterial colonization, and reduce cytotoxic or allergic reactions, and provide similar functional results, compared with synthetic prostheses.…”