title: Delayed primary closure and the incidence of surgical complications in pediatric liver transplant recipients.
abstract: OBJECTIVE
  The purpose of this study was to analyze the general surgical complications in pediatric liver transplant recipients and the safety of delayed primary closure at a single tertiary center.
  
  
  METHODS
  A retrospective review of all liver transplant recipients between April 1986 and May 2014 was performed. All general and gastrointestinal complications were recorded and analyzed. The incidence and risk of these complications were compared between children who had a primary versus those who had a delayed closure, with or without the use of Surgisis®, of their abdomen.
  
  
  RESULTS
  242 patients underwent 281 liver transplants. The median age of the children was 31months. Whole (77), reduced size (91), split (96), and living related grafts (17) were used. General surgical complications were observed in 33 cases (11.7%). 135 cases underwent delayed primary closure (DPC) of their abdomen, 35 with Surgisis®. Patients with biliary atresia had a higher rate (4.6%) of bowel perforation (p=0.013). The majority of complications occurred within 3months of transplantation.
  
  
  CONCLUSIONS
  General surgical complications postpediatric liver transplantation were common but usually not life threatening. Delayed primary closure was safe, had no significant long-term issues, and was not associated with higher incidence of wound related complications.
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia.
authors.forename: William A
authors.initials: WA
authors.lastname: Ziaziaris
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Darani
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia; Pacific Association of Pediatric Surgeons Member.
authors.forename: Andrew J A
authors.initials: AJ
authors.lastname: Holland
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.
authors.forename: Angus
authors.initials: A
authors.lastname: Alexander
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Karpelowsky
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia; Pacific Association of Pediatric Surgeons Member.
authors.forename: Albert
authors.initials: A
authors.lastname: Shun
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia. Electronic address: gordon.thomas@health.nsw.gov.au.
authors.forename: Gordon
authors.initials: G
authors.lastname: Thomas
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects* / Q000295:instrumentation; D000293:Adolescent; D001656:Biliary Atresia / Q000150:complications / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Biliary atresia; Delayed primary closure; Gastrointestinal complications; General surgical complications; Liver transplantation; Pediatric