title: Repair of huge incisional hernias intentionally made during infantile living donor liver transplantation.
abstract: OBJECTIVE
  In some small infants who are transplanted with a large-for-size graft by living donor liver transplantation, an incisional hernia is intentionally made to decrease the tension on the graft. The procedure and timing for repair of this type of hernia were retrospectively evaluated.
  
  
  METHODS
  Repair was carried out in 3 patients at 4 to 11 years after living donor liver transplantation. The preoperative, perioperative, and postoperative statuses were analyzed in each patient.
  
  
  RESULTS
  Fascial closure was possible in all 3 patients. In 2 patients, separation of a component of the rectus sheath or a lower part of the major pectoral muscle was required for approximation of the fascia. One recipient had transient bile leakage that was treated successfully.
  
  
  CONCLUSIONS
  An intentionally made hernia should be as small as possible to facilitate easy primary closure at a later date. A procedure resembling the "clam-shell opening" method, which used a partly separated and extended sheet of the fascia, was feasible to avoid the requirement for an artificial mesh. Preschool ages may be suitable for easier approximation of the fascia.
authors.affiliation: Department of Pediatric Surgery and Transplantation, School of Medicine, Kumamoto University, Kumamoto 860-8556, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Murokawa
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Inomata
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Asonuma
authors.forename: Satsuki
authors.initials: S
authors.lastname: Ogata
authors.forename: Yukika
authors.initials: Y
authors.lastname: Tsukamoto
authors.forename: Lee
authors.initials: L
authors.lastname: Kwang-Jong
authors.forename: Takayuki
authors.initials: T
authors.lastname: Takeichi
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Hideaki
authors.initials: H
authors.lastname: Okajima
mesh_terms: D000005:Abdomen / Q000601:surgery; D000071938:Fasciotomy; D005260:Female; D046449:Hernia, Abdominal; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D008297:Male; D012189:Retrospective Studies; D013526:Surgical Mesh