title: Incisional hernia repair after orthotopic liver transplantation: a technique employing an inlay/onlay polypropylene mesh.
abstract: BACKGROUND
  The literature provides no data on the incidence and operative management of incisional hernias developing after orthotopic liver transplantation. The use of high-dose immunosuppressive agents results in an appreciable delay in wound healing. There is thus a need for a procedure for the reconstruction of the abdominal wall for patients on immunosuppression. The aim of this retrospective study was to establish the incidence of incisional hernias and an analysis of the results after implantation of a polypropylene mesh in inlay-onlay technique after liver transplantation is given.
  
  
  METHODS
  The basis for the present retrospective investigations was a total of 207 liver transplantations carried out in 192 patients (15 re-transplantations). After performing tensiometry, a polypropylene mesh (Marlex) was implanted to close the hernias using the inlay/onlay technique or a direct closure of the fascia was done. All treated hernias were followed up for a median of 18 months.
  
  
  RESULTS
  Among 184 patients, 17 developed incisional hernias after primary direct closure of the abdominal wall, giving an incidence of 9%. In an additional 8 patients an incisional hernia was seen where an absorbable mesh was used to close the abdominal wall after liver transplantation. In addition, there were 25 incisional hernias after 207 liver transplantations (12%). One of 15 (7%) of the surgically repaired hernias with implantation of a polypropylene mesh (Marlex) developed a recurrence. All the 3 patients after direct apposition of the fascia without using a polypropylene mesh suffered a recurrence (3 of 3; 100%). Significant risk factors for developing an incisional hernia were the amount of ascites and the stay in the ICU after transplantation. Neither severe deep nor superficial wound infection nor bowel fistulas were observed after implantation of a inlay/onlay mesh.
  
  
  CONCLUSIONS
  In patients after liver transplantation, the implantation of a polypropylene mesh proved to be an efficient and safe method of treating incisional hernias. Implantation of a mesh was not associated with an increased infection rate, despite the use of immunosuppression. In view of the high recurrence rate associated with primary closure, mesh implantation should be given preference.
authors.affiliation: Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany. volker.mueller@chir.imed.uni-erlangen.de
authors.forename: V
authors.initials: V
authors.lastname: Müller
authors.forename: M
authors.initials: M
authors.lastname: Lehner
authors.forename: P
authors.initials: P
authors.lastname: Klein
authors.forename: W
authors.initials: W
authors.lastname: Hohenberger
authors.forename: R
authors.initials: R
authors.lastname: Ott
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes / Q000008:administration & dosage; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D011126:Polypropylenes