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Justo I, Caso O, Marcacuzco A, Rodríguez-Gil Y, Jiménez-Romero C. Hernia Correction After Liver Transplantation Using Nonvascularized Fascia. Transplant Direct 2024; 10:e1662. [PMID: 38911273 PMCID: PMC11191961 DOI: 10.1097/txd.0000000000001662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 06/25/2024] Open
Abstract
Background Liver transplantation is an increasingly frequent surgical procedure, with elevated rates of postoperative incisional hernias ranging from 5% to 46%. There are numerous known risk factors for incisional hernia, including the type of incision, patient sex, and presence of comorbidities such as diabetes, ascites, older age, and the use of steroids. Most studies on the treatment of incisional hernias in patients who have undergone liver transplantation have shown consistently high rates of complications. Consequently, we propose the use of nonvascular fascia for the symptomatic treatment of incisional hernias in patients with concomitant liver transplantation. Methods We performed our new technique on 8 patients, who had previously undergone liver transplantation, between January 2019 and January 2023. The patients were examined using imaging techniques during the follow-up period. Results Of the 8 patients, 7 were liver transplant recipients and 1 was a combined liver-kidney transplant patient. The median donor age was 57 y (5-66 y), whereas the mean recipient age was 58 y (31-66 y). The median patient height and weight were 163 cm (117-185 cm) and 76 kg (17-104 kg), respectively. Immunosuppression did not change in fascia recipients. The median time between transplantation and hernia repair surgery was 41 mo (5-116 mo). The sizes of the aponeurotic defects varied from 6 × 6 to 25 × 20 cm. Two patients experienced complications: one experienced bulging that required reintervention and the other experienced surgical site seroma. There was no mortality related to the use of the technique, and none were reported during follow-up. Conclusions With its promising results, nonvascularized fascial transplantation can be a successful treatment for incisional hernias in patients who had previously received a liver transplant.
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Affiliation(s)
- Iago Justo
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Oscar Caso
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Alberto Marcacuzco
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Yolanda Rodríguez-Gil
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Carlos Jiménez-Romero
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
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Hassan A, Arujunan K, Mohamed A, Katheria V, Ashton K, Ahmed R, Subar D. Incidence of incisional hernia following liver surgery for colorectal liver metastases. Does the laparoscopic approach reduce the risk? A comparative study. Ann Hepatobiliary Pancreat Surg 2024; 28:155-160. [PMID: 38433531 PMCID: PMC11128795 DOI: 10.14701/ahbps.23-138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 03/05/2024] Open
Abstract
Backgrounds/Aims No reports to compare incisional hernia (IH) incidence between laparoscopic and open colorectal liver metastases (CRLM) resections have previously been made. This is the first comparative study. Methods Single-center retrospective review of patients who underwent CRLM surgery between January 2011 and December 2018. IH relating to liver surgery was confirmed by computed tomography. Patients were divided into laparoscopic liver resection (LLR) and open liver resection (OLR) groups. Data collection included age, sex, presence of diabetes mellitus, steroid intake, history of previous hernia or liver resection, subcutaneous and peri-renal fat thickness, preoperative creatinine and albumin, American Society of Anesthesiologists (ASA) score, major liver resection, surgical site infection, synchronous presentation, and preoperative chemotherapy. Results Two hundred and forty-seven patients were included with a mean follow-up period of 41 ± 29 months (mean ± standard deviation). Eighty seven (35%) patients had LLR and 160 patients had OLR. No significant difference in the incidence of IH between LLR and OLR was found at 1 and 3 years, respectively ([10%, 19%] vs. [10%, 19%], p = 0.95). On multivariate analysis, previous hernia history (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.56-4.86) and subcutaneous fat thickness (HR, 2.22; 95% CI, 1.19-4.13) were independent risk factors. Length of hospital stay was shorter in LLR (6 ± 4 days vs. 10 ± 8 days, p < 0.001), in comparison to OLR. Conclusions In CRLM, no difference in the incidence of IH between LLR and OLR was found. Previous hernia and subcutaneous fat thickness were risk factors. Further studies are needed to assess modifiable risk factors to develop IH in LLR.
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Affiliation(s)
- Ahmed Hassan
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
- Blackburn Research Innovation Development Group in General Surgery (BRIDGES), Royal Blackburn Hospital, Blackburn, UK
| | - Kalaiyarasi Arujunan
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Ali Mohamed
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Vickey Katheria
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Kevin Ashton
- University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
| | - Rami Ahmed
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Daren Subar
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
- Blackburn Research Innovation Development Group in General Surgery (BRIDGES), Royal Blackburn Hospital, Blackburn, UK
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Avramidou E, Terlemes K, Lymperopoulou A, Katsanos G, Antoniadis N, Kofinas A, Vasileiadou S, Karakasi KE, Tsoulfas G. Minimally Invasive Surgery in Liver Transplantation: From Living Liver Donation to Graft Implantation. LIVERS 2024; 4:119-137. [DOI: 10.3390/livers4010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2024] Open
Abstract
Since the end of the 20th century and the establishment of minimally invasive techniques, they have become the preferred operative method by many surgeons. These techniques were applied to liver surgery for the first time in 1991, while as far as transplantation is concerned their application was limited to the living donor procedure. We performed a review of the literature by searching in Pubmed and Scopus using the following keywords: Liver transplantation, Minimally invasive surgery(MIS) living liver donor surgery. Applications of MIS are recorded in surgeries involving the donor and the recipient. Regarding the recipient surgeries, the reports are limited to 25 patients, including combinations of laparoscopic, robotic and open techniques, while in the living donor surgery, the reports are much more numerous and with larger series of patients. Shorter hospitalization times and less blood loss are recorded, especially in centers with experience in a large number of cases. Regarding the living donor surgery, MIS follows the same principles as a conventional hepatectomy and is already the method of choice in many specialized centers. Regarding the recipient surgery, significant questions arise mainly concerning the safe handling of the liver graft.
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Affiliation(s)
- Eleni Avramidou
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Konstantinos Terlemes
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Afroditi Lymperopoulou
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Georgios Katsanos
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Nikolaos Antoniadis
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Athanasios Kofinas
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Stella Vasileiadou
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Konstantina-Eleni Karakasi
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
| | - Georgios Tsoulfas
- Department of Transplant Surgery, Center for Research and Innovation in Solid Organ Transplantation Aristotle University of Thessaloniki School of Medicine, 54642 Thessaloniki, Greece
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López-López V, Martínez-Serrano MÁ, Ruiz-Manzanera JJ, Eshmuminov D, Ramirez P. Minimally invasive surgery and liver transplantation: is it a safe, feasible, and effective approach? Updates Surg 2023:10.1007/s13304-023-01506-7. [PMID: 37014619 DOI: 10.1007/s13304-023-01506-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Abstract
The minimally invasive approach (MIS) is undoubtedly one of the most important breakthroughs in surgery in recent decades. Consequently, MIS has been increasingly in the field of liver transplantation (LT). The objective of the present review was to determine the current status of MIS with respect to liver transplantation (LT) and what would be the indications for an MIS in this context today. The literature was searched for publications reporting the MIS in LT. Only those articles that described the results according to whether the MIS had been performed to treat transplant complications (urgent or late), another pathology not related to the LT, or to perform the liver explantation and graft implantation were included. From 2000 to 2022, 33 studies and 261 patients were included. Most frequent indications were incisional hernias secondary to LT followed by the treatment of other pathologies not related with the LT and treatment of LT complications. Only a 12% were urgent interventions. Few studies describe conversions with an average rate of 2.5%. Morbidity do not differ significantly from open surgery. No case of mortality or graft loss was described. Purely laparoscopic liver explants in 9 patients with 2 conversions and 3 cases of graft implantation with a higher warm ischemia in the MIS implants grafts were described. The limitations of MIS in LT are relative and probably depend more on training, experience, and skills of the surgeons. This approach could be safety and feasibility to solved complications or in other individualized indications in LT patients. The initial experiences in liver explant and graft implantation need further investigations.
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Affiliation(s)
- Víctor López-López
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, El Palmar, 30120, Murcia, Spain.
| | | | - Juan José Ruiz-Manzanera
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, El Palmar, 30120, Murcia, Spain
| | - Dilmurodjon Eshmuminov
- Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland
| | - Pablo Ramirez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, El Palmar, 30120, Murcia, Spain
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Incisional Hernia Repaired Using Thigh Muscle Fascia After Kidney Transplantation: A Case Report. Transplant Proc 2022; 54:533-536. [PMID: 35033368 DOI: 10.1016/j.transproceed.2021.09.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although monofilament mesh-based repair is a safe and effective procedure for incisional hernia (IH) in organ transplant patients, there is no definite evidence of IH treatment for patients with graft rejection and enhanced immunosuppressive therapy. We report a successful case of large IH repair using an autologous thigh muscle fascia sheet in a kidney transplant patient. CASE PRESENTATION A 69-year-old man had IH from the incision of kidney transplantation, which was performed 6 years ago. He had a large right lower abdominal distension hanging down to the inguinal portion. A computed tomography scan revealed a large IH with a maximum abdominal defect diameter of 15 cm. The hernia sac contained the intestine, colon, and transplanted kidney, which had pulled out along with the retroperitoneum and protruded into the abdominal wall. He had chronic active acute antibody-mediated rejection, which required frequent steroid pulse therapy and additional or adjusted immunosuppressive drugs. After total circumferential exposure of the hernia sac and abdominal fascia, the abdominal wall defect was closed using a horizontal mattress suture. The sutured line was covered with a thigh muscle fascia sheet harvested from the patient's right femur and attached to the closed fascia. He was discharged on postoperative day 13 without any complications, and no IH recurrence was observed 10 months after surgery. CONCLUSIONS Hernia repair using autologous tissue could be a treatment option for post-transplant IH with a higher risk of infection.
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Ferri JVV, Dick SM, Grezzana-Filho TDJM, Feier FH, Prediger L, Lazzaretti GS, Kruel CRP, Corso CO, Cavazzola LT, Chedid MF. EARLY INCISIONAL HERNIA AFTER LIVER TRANSPLANTATION: RISK FACTORS AND HERNIA REPAIR RESULTS. ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1698. [DOI: 10.1590/0102-672020220002e1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022]
Abstract
ABSTRACT BACKGROUND: Liver transplantation is a complex and valuable therapy. However, complications that burden postoperative quality of life, such as incisional hernia, are to be better elucidated, such as risk factors and prophylactic measures. AIM: This study aimed to define the rate of incisional hernia in patients who underwent liver transplantation in a population in southern Brazil and to assess the related risk factors in order to establish measures for prior optimization and specific prophylactic care in the future. METHODS: Patients undergoing adult Liver transplantation from January 2004 to November 2020 were retrospectively analyzed, assessing demographic features, surgical outcomes, and predisposing factors. RESULTS: Among 261 liver transplantation patients included, incisional hernia was diagnosed in 71 (27.2%). Of the 71 incisional hernia patients, 28 (39.4%) developed IH during the first post-transplant. Majority of the patients were male (52/71, 73.2%); of the 71 patients, 52 had hepatitis C virus (HCV) and 33 (46.5%) had hepatocellular carcinoma (HCC). Male gender (p=0.044), diabetes mellitus (p=0.008), and acute cellular rejection (p<0.001) were risk factors for IH. In all, 28 (39.4%) patients were submitted for hernia repair with mesh, with a recurrence rate of 17.8%. CONCLUSION: Incisional hernia after liver transplantation is a relatively common problem associated with male gender, diabetes, and acute cellular rejection. This is a problem that should not be trivialized in view of the complexity of liver transplantation, as it can lead to a reduction in quality of life as well as jeopardize late liver transplantation results and lead to incarceration and strangulation.
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Zarbaliyev E, Sevmiş M, Kilercik H, Çelik S, Aktaş S, Çağlıkülekçi M, Sevmiş Ş. Is the incision type important for the development of hernia in liver transplant patients? Clin Transplant 2021; 36:e14497. [PMID: 34591336 DOI: 10.1111/ctr.14497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/04/2021] [Accepted: 09/25/2021] [Indexed: 12/07/2022]
Abstract
OBJECTIVE In this study, we aimed to investigate the rates and causes of incisional hernia that developed in the postoperative follow-up of patients who underwent liver transplantation. MATERIAL AND METHOD The results of patients who underwent LT by using three different incisions at the İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital organ transplant center between January 2015 and December 2019 were retrospectively analyzed. Patients were divided into Chevron (group-1), reverse T (group-2), and J incisions (group-3) and hernia development rates were examined. RESULTS There was no significant difference in terms of incisional hernia in groups 1 and 2 according to the incision type (p = .723). Incisional hernia rate was significantly lower in the J incision group (p < .001). When the factors that increase the development of hernia in all LT patients were examined, it was seen that male gender (p = .021), high BMI rate (p = .003), postoperative bleeding (p = .018), and wound infection (p = .039) caused a significant increase in risk. CONCLUSION The incision, which is made during liver transplant, is important for the development of hernia. The J incision has a low hernia development rate without causing access problems. Regardless of the incision, high BMI index, male gender, postoperative bleeding, and wound infection increase the development of incisional hernia in liver transplant patients.
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Affiliation(s)
- Elbrus Zarbaliyev
- Department of General Surgery, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
| | - Murat Sevmiş
- Department of General Surgery and Transplantation, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
| | - Hakan Kilercik
- Department of Anesthesiology, Gaziosmanpaşa Hospital, Yeni Yüzyıl University, İstanbul, Turkey
| | - Sebahattin Çelik
- Department of General Surgery, Van Training and Research Hospital, Health Scıences Unıversıty, Van, Turkey
| | - Sema Aktaş
- Department of General Surgery and Transplantation, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
| | - Mehmet Çağlıkülekçi
- Department of General Surgery, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
| | - Şinasi Sevmiş
- Department of General Surgery and Transplantation, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
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Augenstein V, Ayuso S, Elhage S, George M, Anderson M, Levi D, Heniford BT. Management of incisional hernias in liver transplant patients: Perioperative optimization and an open preperitoneal repair using porcine-derived biologic mesh. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_14_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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An invited commentary on "incisional hernia after liver transplantation: Risk factors, management strategies and long-term outcomes of a cohort study". Int J Surg 2020; 80:40. [PMID: 32574753 DOI: 10.1016/j.ijsu.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 11/21/2022]
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