title: Laparoscopic treatment of subxiphoid incisional hernias in cardiac transplant patients.
abstract: BACKGROUND
  Symptomatic subxiphoid incisional hernias present difficult surgical problems, especially in immuno-suppressed cardiac transplant patients. Here, we describe the laparoscopic repair of subxiphoid incisional hernias in patients with a history of cardiac transplantation.
  
  
  METHODS
  Four patients with subxiphoid hernias who had previously undergone heart transplantation were identified from a prospective database. Each underwent a laparoscopic repair with mesh implantation.
  
  
  RESULTS
  Three patients had a previous open repair. The mean age was 62.5 years, an average of 64.3 months after transplantation. At the time of surgery, all patients were immunosuppressed, and each had a subxiphoid, poststernotomy incisional hernia. Gore dual mesh was used in 2 patients, while Parietex mesh was used in 2. Mean operative time was 122 minutes, and all were completed laparoscopically. The mean length of stay was 6.5 days, and the mean defect size was 286.25 cm(2). There was a significant correlation between hernia size and length of stay (P=0.037). Postoperatively, one patient (25%) developed pulmonary edema, and 1 patient (25%) had a prolonged ileus.
  
  
  CONCLUSIONS
  Symptomatic subxiphoid incisional hernias are a challenging surgical problem in patients with a history of sternotomy. Laparoscopic repair is safe and effective in immunosuppressed patients who have previously undergone cardiac transplantation.
authors.affiliation: Department of Surgery, Palo Alto Veterans' Affairs Health Care System, Stanford University School of Medicine, Palo Alto, California 94304, USA. de1@stanford.edu
authors.forename: Dan
authors.initials: D
authors.lastname: Eisenberg
authors.forename: Wanda M
authors.initials: WM
authors.lastname: Popescu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Duffy
authors.forename: Robert L
authors.initials: RL
authors.lastname: Bell