Outcomes analysis of laparoscopic ventral hernia repair in transplant patients.
OBJECTIVE
Postoperative wound complications are minimized after laparoscopic ventral hernia repair (LVHR) while maintaining low recurrence rates and acceptable morbidity. The purpose of this study is to evaluate efficacy and safety of LVHR in patients after organ transplantation in comparison to a large cohort of nontransplantation patients after LVHR.


METHODS
A retrospective, institutional review board (IRB)-approved review was performed on 347 patients who underwent LVHR between July 2000 and December 2007.


RESULTS
LVHR was successfully completed in 38/38 transplantation patients (n = 21 liver, n = 5 cardiac, n = 8 kidney, n = 1 lung/kidney, n = 2 kidney/pancreas, n = 1 double lung) without conversion and in 301/309 (97.4%) nontransplant patients. Previous hernia repairs were attempted in 5/38 (13.2%) of the transplant patients and 108/309 (35.0%) of nontransplantation patients. Mean defect size was 256 cm(2) (p < 0.00001) and mesh size 780 cm(2) (p < 0.00001) in the transplantation patients, and 140 cm(2) and 426 cm(2) in nontransplantation patients, respectively. Mean operating time was similar between the two groups (216.9 min versus 184.0 min). Perioperative complication rate was similar between groups (34.2% versus 34.3%, p = 1.0). There were three (1.0%) mesh infections and two (0.6%) mortalities in the nontransplantation patients and one mesh infection and no mortalities in the transplantation group. At mean follow-up of 20.0 (range 1.1-41) months in the transplantation group and 5.0 (range 1-38) months in the nontransplantation group, the hernia recurrence rate was 7.9% and 2.9%, respectively (p = 0.1330).


CONCLUSIONS
Perioperative complication and hernia recurrence rates in transplant patients after LVHR are comparable to nontransplant patients, although the transplantation patients had significantly larger hernias. LVHR should be considered to manage ventral incisional hernias post transplantation.
Harold
Kristi
K
Department of Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA. harold.kristi@mayo.edu
Mekeel
Kristin
K
Spitler
Jennifer
J
Frisella
Margaret
M
Merritt
Marianne
M
Tessier
Deron
D
Matthews
Brent
B
D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D045823:Ileus / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome