An Improved Surgical Technique for Incisional Hernia Repair following Liver Transplantation
Steven J. Hermiz, MD, Jerec Ricci, MD, Marion Tapp, MS, Kevin Delaney, MD, Fernando Herrera, MD, Milton Armstrong, MD.
Medical University of South Carolina, Charleston, SC, USA.
Purpose- Incisional hernias are well-known complications of liver transplantation with an incidence of 4% to 20%. Furthermore, incisional hernia recurrence remains a significant problem due to the use of immunosuppressive agents and incision size. The optimal technique for hernia repair remains controversial; several studies have demonstrated favorable results with component separation (CS) with porcine cellular dermal matrix (Strattice) reinforcement. The purpose of our study was to identify surgical techniques associated with the lowest rate of incisional hernia recurrence following liver transplantation.
Methods- A retrospective review was performed on 28 liver transplant patients who underwent incisional hernia repair over the last 9 years in a single institution. Patient charts were queried for age, BMI, race, pre-operative lab values, date of transplant, prior hernia operations, operative technique, operation time, smoking status, and follow up. Patients were divided into two cohorts based on initial hernia operative technique: CS with Strattice underlay versus all other techniques. These two groups were then compared by chi-square analysis using SPSS software.
Results- A total of 28 liver transplant patients developed postoperative incisional hernias. There were 14 patients in the CS with Strattice underlay group and fourteen in the "all other techniques". Nine patients developed a recurrence. There was a significant difference in recurrence in those who underwent first-time incisional hernia repair using a CS with Strattice underlay technique as compared to all other techniques (0% vs. 64%, respectively, p = 0.0003). Ultimately, 18 of the initial 28 patients were successfully managed using a CS with Strattice underlay (64%), 14 during their initial repair and 4 during subsequent repairs.
Conclusion-Liver transplant patients undergoing postoperative incisional hernia repair appear to have lower rates of recurrence when repaired using a CS with Strattice underlay technique.
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