title: Laparoscopic incisional hernia repair after liver transplantation.
abstract: Incisional hernias occur in up to 17% of patients after liver transplantation. Laparoscopic ventral hernia repair is associated with fewer wound complications and a decreased incidence of recurrence when compared to open hernia repair in nontransplant patients. This is a retrospective review of 13 patients who underwent laparoscopic incisional hernia repair (LAP group) after liver transplantation compared to 14 patients who had open repairs (OP group; all but one with mesh). Primary immunosuppression in both groups at the time of transplantation was tacrolimus, but more patients in the LAP group were on sirolimus at the time of hernia, while more patients in the OP group were on prednisone at the time of hernia repair. All operations were completed with a laparoscopic approach; there were no conversions to open. Length of stay differed significantly between the 2 groups, with a mean of 5.4 days for the LAP group compared to 2.7 days in the OP group (0.0059). Complications occurred in 2 (15%) of the patients in the LAP group and 5 (36%) in the OP group. One patient in the LAP group required mesh removal to exclude causes of recurrent ascites, and 1 in the OP group for mesh infection. One (7.6%) of the patients in the LAP group developed a recurrence, compared to 29% (4) of the OP group (P =0.3259). In conclusion, laparoscopic incisional hernia repair is safe in patients after liver transplantation, with a low risk of infection or recurrence.
authors.affiliation: Division of Transplant Surgery and General Surgery, Mayo Clinic Hospital, Phoenix, AZ 85254, USA. mekeel.kristin@mayo.edu
authors.forename: Kristin
authors.initials: K
authors.lastname: Mekeel
authors.forename: David
authors.initials: D
authors.lastname: Mulligan
authors.forename: Kunam Sudhakar
authors.initials: KS
authors.lastname: Reddy
authors.forename: Adyr
authors.initials: A
authors.lastname: Moss
authors.forename: Kristi
authors.initials: K
authors.lastname: Harold
mesh_terms: D000368:Aged; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D010535:Laparoscopy; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use; D013526:Surgical Mesh / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000453:epidemiology; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D011241:Prednisone; D020123:Sirolimus; D016559:Tacrolimus