Incisional hernia after simultaneous pancreas kidney tranplantation: a single-center experience from Budapest.

INTRODUCTION

The occurrence of postoperative incisional hernia is more frequent after simultaneous pancreas-kidney transplantation compared with other transplanted parenchymal organs. These complications are especially dangerous in this patient population, because they can compromise the survival of the transplanted organ.

METHODS

We performed a retrospective review of a series of adult patients with incisional herniae after 23 consecutive simultaneous pancreas-kidney transplantations between January 2004 and June 2010 seeking to identify risk factors. All 23 patients had a body mass index (BMI) of <25. All surgeons used a similar technique, including a median incision with an intraperitoneal approach, and systemic venous and enteric drainage methods and a layered fascial closure. All combined pancreas-kidney transplant recipients received induction with thymoglobulin and maintenance therapy with sirolimus, reduced-dose cyclosporine and corticosteroids.

RESULTS

An incisional hernia repair was performed in 8/23 patients (34.8%). Four reoperations were required in this group (50%), due to hemoperitoneum (n=2), intra-abdominal abscess (n=1), and venous thrombosis (n=1). The mean elapsed time between transplantation and hernioplasty was 24.5 months (range, 8-51). There was no significant difference in age, gender, BMI, dialysis modality, or operative time among affected compared with the other members of the group.

CONCLUSION

Despite lack of obesity we observed a relatively higher rate of postoperative herniase, possibly owing to the side effects of a thymoglobulin-sirolimus combination.