title: Feasibility and effectiveness of laparoscopic incisional hernia repair after liver transplantation.
abstract: BACKGROUND
  Incisional hernia is a frequent problem after liver transplantation. It is related to immunosuppression, use of steroids, obesity, as well as the type of incision. Laparoscopic repair shows a lower rate of complications in terms of infection and recurrence, as well as reduced postoperative pain and faster recovery.
  
  
  METHODS
  We reviewed our experience with laparoscopic incisional hernia repair (LIHR) in patients after liver transplantation, using the BARD Composix mesh which is composed of two layers of polypropylene and polytetrafluoroethylene (PTFE) and fixed with metal ProTack.
  
  
  RESULTS
  Between March 2002 and April 2010, we performed 20 LIHR in 17 male and three female subjects of overall mean age of 58.3 years, and body mass Index of 31.05 kg/m(2). The mean size of the defects was 215.25 cm(2). All patients had undergone bilateral subcostal incisions with a midline extension, and seven had additional operations after the transplantation for various reasons. There were no differences in immunosuppression. Three patients had needed steroid boluses for acute graft rejection episodes. There was no conversion of therapy. The size of mesh was 18 × 23 cm in seven cases and 20 × 25 in 12 cases. The mean postoperative hospital stay was 2.1 days. Oral feeding was initiated a few hours after surgery, and routine immunosuppression was not discontinued. There were no major early complications. During follow-up, we identified one patient with a mesh infection (5%) and one with a recurrence (5%).
  
  
  CONCLUSIONS
  LIHR is safe and feasible even for major hernias after liver transplantation with few complications.
authors.affiliation: Department of General Surgery, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain. rjgianchandani@hotmail.com
authors.forename: R
authors.initials: R
authors.lastname: Gianchandani
authors.forename: E
authors.initials: E
authors.lastname: Moneva
authors.forename: P
authors.initials: P
authors.lastname: Marrero
authors.forename: M
authors.initials: M
authors.lastname: Alonso
authors.forename: M J
authors.initials: MJ
authors.lastname: Palacios
authors.forename: J M
authors.initials: JM
authors.lastname: Del Pino
authors.forename: V
authors.initials: V
authors.lastname: Concepción
authors.forename: M
authors.initials: M
authors.lastname: Barrera
authors.forename: A
authors.initials: A
authors.lastname: Soriano
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006547:Hernia / Q000209:etiology; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy / Q000592:standards / Q000706:statistics & numerical data*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged