Incisional hernia after liver transplantation: Risk factors, management strategies and long-term outcomes of a cohort study
- 1 June 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in International Journal of Surgery
- Vol. 78, 149-153
- https://doi.org/10.1016/j.ijsu.2020.04.048
Abstract
Introduction: Incisional hernias (IH) develop in up to 40% of liver transplant (LT) recipients and can contribute to considerable morbidity. Materials and methods: A single center retrospective review of a prospectively maintained LT database was conducted to identify all patients diagnosed with IH after LT during a 13-year study period (2003-2015). Analyzed data included patient demographics, LT details, incidence and timing of IH, risk factors, management strategies and long-term outcomes. Results: During the 13-year study period, IH was diagnosed in 16.7% (163/976) of LT recipients after a median of 19.6 months (range 6.7-49.5 months) from transplant surgery. Identified risk factors for developing IH included male gender (p < 0.001) while acute cellular rejection (ACR) was found to be negatively associated with the risk of developing IH (p = 0.014). Acute incarceration/strangulation was seen in 4 patients with IH while the remaining (n = 159) presented with non-emergent symptoms. Surgical repair was undertaken in 70/163 (43%) IH patients after medical optimization when possible (open repair 83%, mesh use 90%). IH recurrence rate was 14.3% (10/70) with comparable rates in no-mesh and with-mesh repairs (42.9% vs. 11.3%; p = 0.057) and open (15.8%) and laparoscopic (9.1%) approaches (p = 0.68). Conclusion: IH is a late complication following LT and male gender is a consistent predictive marker. Acute presentation is infrequent and elective repair can be planned in most patients allowing for risk factor optimization to ensure promising long-term outcomes.Keywords
This publication has 24 references indexed in Scilit:
- Incisional hernia after liver transplantation: risk factors and health‐related quality of lifeClinical Transplantation, 2014
- Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgeryThe American Journal of Surgery, 2014
- Liver transplantation: a systematic review of long‐term quality of lifeLiver International, 2014
- Incisional Hernia in Recipients of Adult to Adult Living Donor Liver TransplantationWorld Journal of Surgery, 2014
- Meta-Analysis of Primary Mesh Augmentation as Prophylactic Measure to Prevent Incisional HerniaDigestive Surgery, 2013
- Incidence, risk factors and management of incisional hernia in a high volume liver transplant centerAnnals of Transplantation, 2013
- Centre volume and resource consumption in liver transplantationHPB, 2012
- Posterior and open anterior components separations: a comparative analysisThe American Journal of Surgery, 2012
- Incidence, predisposing factors, and results of surgical treatment of incisional hernia after orthotopic liver transplantationTransplantation Proceedings, 2004
- Incisional HerniasDigestive Surgery, 2003