title: A comparative outcome analysis of incisional hernia repair in patients who underwent liver transplantation vs. those that underwent hepatopancreaticobiliary surgery using the EHS guidelines as a means of comparison.
abstract: OBJECTIVE
  We retrospectively analyzed incisional hernia (IH) outcomes of liver transplant (LT) vs. hepatopancreaticobiliary (HPB) cases sharing the same incision.
  
  
  METHODS
  IH repair patients with a history of LT were compared with those with HPB surgical history sharing the same type of incision and using the European Hernia Society classification and nomenclature for reporting outcome.
  
  
  RESULTS
  Eighty-two patients (27 HPB and 55 LT) between February 2001 and February 2014 were analyzed. Baseline demographics showed that the LT group had more diabetes and steroid use, but were less physical active. Outcomes showed no differences in wound complication, SSI rate, and recurrence rate (recurrence rate of 11.1% and 16.4% for HPB and LT, respectively). Multivariate analysis showed longer operating time to be a risk factor for both wound complication and SSI. M-tor inhibitor use was an additional risk factor for SSI. Interval to recurrence was significant longer in the LT group (35 vs. 61 months). Cox analysis showed steroid use, immunosuppression and not using a synthetic mesh as risk factors for recurrence.
  
  
  CONCLUSIONS
  Incisional hernia repair with synthetic mesh after liver transplantation does not result in more wound complications, SSI, and recurrences, when compared to patients without immunosuppression.
authors.affiliation: Department of General, Hepatopancreaticobiliary and Liver Transplantation Surgery, Ghent University Hospital, Gent, Belgium.
authors.forename: Hwai-Ding
authors.initials: HD
authors.lastname: Lam
authors.affiliation: Department of General, Hepatopancreaticobiliary and Liver Transplantation Surgery, Ghent University Hospital, Gent, Belgium.
authors.forename: Aude
authors.initials: A
authors.lastname: Vanlander
authors.affiliation: Department of General, Hepatopancreaticobiliary and Liver Transplantation Surgery, Ghent University Hospital, Gent, Belgium.
authors.forename: Frederik
authors.initials: F
authors.lastname: Berrevoet
mesh_terms: D001660:Biliary Tract Diseases / Q000150:complications / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D000069290:Incisional Hernia / Q000209:etiology / Q000517:prevention & control*; D008107:Liver Diseases / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010182:Pancreatic Diseases / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control; D014945:Wound Healing
keywords: hepatopancreaticobiliary surgery; immunosuppression; incisional hernia; liver transplantation; outcome