Incidence and management of abdominal closure-related complications in adult intestinal transplantation.
BACKGROUND
We sought to determine the best strategy to overcome difficult abdominal wall closures in intestinal transplantation (ITx).


METHODS
Among 38 adult recipients of 39 ITxs from deceased donors, the median number of previous laparotomies was 2.0 per patient, with a median donor-to-recipient body weight ratio of 1.1. Eight patients (21%) had full residual intestinal length before transplant. Abdominal wall closure after transplant was considered difficult in 15 (39.5%) patients (group A). To overcome size mismatching, we performed two graft reductions, five skin-only closures, one two-step abdominal wall closure, four prosthetic mesh closures, and three abdominal wall transplants. In the remaining 23 (60.5%) patients, a regular abdominal closure was performed (group B).


RESULTS
Twelve patients (32%) experienced complications related to abdominal wall closure, 10 (67%) in group A and 2 (8.7%) in group B (P<0.0001). Abdominal closure-related mortality was 6.7% (1/15) and 4.3% (1/23), respectively (P=1.0). In group A, there were six incisional hernias (one of them after abdominal wall transplant), although all four patients with mesh experienced mesh infection. Two of them developed intestinal fistulae, leading to patient death in one case. In group B, one patient with unfavorable donor/recipient size matching had fatal vascular thrombosis of a multivisceral graft caused by compression after abdominal closure.


CONCLUSIONS
A careful evaluation of abdominal cavity is necessary in candidates for ITx. In our experience, closure with mesh should be avoided because of the high rate of complications. Abdominal wall transplantation is a feasible option when a difficult abdominal wall closure is expected.
Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy.
Chiara
C
Zanfi
Matteo
M
Cescon
Augusto
A
Lauro
Alessandro
A
Dazzi
Giorgio
G
Ercolani
Gian Luca
GL
Grazi
Massimo
M
Del Gaudio
Matteo
M
Ravaioli
Alessandro
A
Cucchetti
Giuliano
G
La Barba
Matteo
M
Zanello
Riccardo
R
Cipriani
Antonio Daniele
AD
Pinna
D034861:Abdominal Wall / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007422:Intestines / Q000637:transplantation*; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000379:methods*; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000295:instrumentation; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome