title: Ventral incisional hernia (VIH) repair after liver transplantation (OLT) with a biological mesh: experience in 3 cases.
abstract: BACKGROUND
  Hernias after orthotopic liver transplant (OLT) occur in about 30 % of cases. Predisposing factors in liver cirrhotic patients of cases are ascites, low abdominal muscle mass and cachexia before and immunosuppression after OLT. Standard operative transplant-technique even in small hernias is to implant a mesh. For patients after liver transplantation a porcine non-cross linked biological patch being less immunogenic than synthetic and cross-linked meshes is chosen for ventral incisional hernia repair.
  
  
  METHODS
  3 patients (1 female, 2 male), OLT indications Hepatitis C, exogenous- toxic cirrhosis, median-age 53 (51 - 56) and median time to hernia occurrence after OLT were 10 month (6 - 18 m) are documented. 2 patients suffered from diabetes, 2 from chronic-obstructive lung disease. Maintenance immunosuppressions were Everolimus in 1 patient, Everolimus + MMF in the second and Everolimus +Tacrolimus in the third patient. The biological was chosen for hernia repair due to the preexisting risk- factors. Meshes, 10 × 16 cm were placed, in IPOM (Intra-Peritonel-Onlay-Mesh) -position by relaparatomy. Insolvable, monofile, interrupted sutures were used.
  
  
  RESULTS
  All patients recovered primarily, and were dismissed within 10 d post OP. No wound healing disorders or signs of postoperative infections occurred. All are free of hernia recurrence in a mean observation time of 22 month (10 - 36).
  
  
  CONCLUSIONS
  The usage of porcine non-cross-linked biological patches seems feasible for incisional hernia repair after OLT. Wound infections in these patients have been observed with other meshes. Further investigation is needed to prove potential superiority of this biological to the other meshes.
authors.affiliation: Clinical Department for Transplantation Surgery, Medical University Graz, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Schaffellner
authors.affiliation: Clinical Department for Transplantation Surgery, Medical University Graz, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Sereinigg
authors.affiliation: General Surgery, Medical University Graz, Austria.
authors.forename: D
authors.initials: D
authors.lastname: Wagner
authors.affiliation: Clinical Department for Transplantation Surgery, Medical University Graz, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Jakoby
authors.affiliation: Clinical Department for Transplantation Surgery, Medical University Graz, Austria.
authors.forename: D
authors.initials: D
authors.lastname: Kniepeiss
authors.affiliation: Clinical Department for Transplantation Surgery, Medical University Graz, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Stiegler
authors.affiliation: Pathology, Medical University Graz, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Haybäck
authors.affiliation: Clinical Department for Transplantation Surgery, Medical University Graz, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Müller
mesh_terms: D062088:Acellular Dermis; D005260:Female; D006547:Hernia / Q000175:diagnosis* / Q000209:etiology*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D013526:Surgical Mesh; D016896:Treatment Outcome