title: Incidence, risk factors and management of incisional hernia in a high volume liver transplant center.
abstract: BACKGROUND
  Incisional hernia after liver transplantation is a common complication with an incidence between 5% and 34%. This prospective study analyzed risk factors, surgical management and long-term results after hernia repair.
  
  
  METHODS
  From February 2002 until August 2009, 810 liver transplantations were performed. 77 patients (9.5%) underwent incisional hernia repair after a median time of 21.1 months (4.6-76.7) following transplant. These patients were compared to patients without hernia (n=733).
  
  
  RESULTS
  No statistically significant differences between the groups were observed with respect to gender, underlying liver disease, Child-Pugh classification, MELD-Score and preoperative renal failure (p=NS). Multivariate analysis revealed advanced age (p=0.014), body mass index (p=0.016), and re-laparotomies (p<0.001) as independent risk factors for incisional hernias. Pre-existing diabetes mellitus and immunosuppression with mycophenolate mofetil reached significance only in the univariate analysis (p<0.001). Recurrent hernia was observed in 12 of 77 patients (15.6%) at a median time of 7.9 months (4.8-46.8) after primary surgical repair. The recurrence rate after intraperitoneal onlay mesh implantation was lower compared to other mesh techniques (7.7% vs. 21.4%).
  
  
  CONCLUSIONS
  The risk factors for the development of incisional hernias in liver transplant patients are similar to patients with prior abdominal surgery for other reasons. Intraperitoneal onlay mesh implantation may lead to a decrease of hernia recurrences. The role of immunosuppression in the genesis of incisional hernias requires further elucidation.
authors.affiliation: General, Visceral and Transplant Surgery, Charité - Campus Virchow Clinic, Universitätsmedizin Berlin, Berlin, Germany. panagiotis.fikatas@charite.de
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Fikatas
authors.forename: Wentzel
authors.initials: W
authors.lastname: Schoening
authors.forename: Ji-Eun
authors.initials: JE
authors.lastname: Lee
authors.forename: Sascha Santosh
authors.initials: SS
authors.lastname: Chopra
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.forename: Olaf
authors.initials: O
authors.lastname: Guckelberger
authors.forename: Gero
authors.initials: G
authors.lastname: Puhl
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Sven C
authors.initials: SC
authors.lastname: Schmidt
mesh_terms: D005260:Female; D005858:Germany / Q000453:epidemiology; D006555:Hernia, Ventral / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013526:Surgical Mesh