title: Laparoscopic repair of incisional hernia in solid organ-transplanted patients: the method of choice?
abstract: Due to immunosuppressive (IS) therapy, incisional hernias are overrepresented in the organ-transplanted (Tx) population with larger defects, a high rate of recurrence, and a tendency toward more seromas and infectious problems. Thirty-one Tx/IS patients with a control group of 70 non-IS patients with incisional hernia (6/7 recurrences) were included in a prospective interventional study. Both cohorts were treated with laparoscopic ventral hernia repair (LVHR). Follow-up time and rate was 37 months and 95%. One hundred LVHR's were completed as there was one conversion in the Tx/IS group. No late infections or mesh removals occurred. Recurrence rates were 9.7% vs. 4.2% (P = 0.37) and the overall complication rates were 19% vs. 27% (P = 0.80). The Tx/IS group had a higher mesh-protrusion rate (29% vs. 13%, P = 0.09), but also larger hernias. Polycystic kidney disease was overrepresented in the Tx cohort (44% of kidney-Tx). Incisional hernias in Tx/IS patients may be treated by LVHR with the same low complication rate and recurrence rate as non-IS patients. By LVHR, the highly problematic seroma/infection problems encountered in Tx/IS patients treated by conventional open technique seem almost eliminated. The minimally invasive procedure seems particularly rational in the Tx/Is population and should be the method of choice. (ClinicalTrials.gov number: NCT00455299, date: 5 May 2006).
authors.affiliation: Surgical Department, Sykehuset Innlandet Health Trust, Brumunddal, Norway.
authors.forename: Jan R
authors.initials: JR
authors.lastname: Lambrecht
authors.forename: Morten
authors.initials: M
authors.lastname: Skauby
authors.forename: Erik
authors.initials: E
authors.lastname: Trondsen
authors.forename: Arild
authors.initials: A
authors.lastname: Vaktskjold
authors.forename: Ole M
authors.initials: OM
authors.lastname: Øyen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000009:adverse effects*; D010535:Laparoscopy / Q000379:methods*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D013526:Surgical Mesh
keywords: hernia; laparoscopy; mesh; organ; repair; transplant