Damiano G, Palumbo V D, Fazzotta S, Buscemi S, Ficarella S, Maffongelli A, Buscemi G, Lo Monte A I
Department of Surgical, Oncological and Oral Sciences, Università degli Studi di Palermo, Palermo, Italy.
Department of Surgical, Oncological and Oral Sciences, Università degli Studi di Palermo, Palermo, Italy.
Transplant Proc. 2019 Jan-Feb;51(1):215-219. doi: 10.1016/j.transproceed.2018.04.084. Epub 2018 Jun 30.
Incisional hernia in renal transplant patients is a complication that negatively affects the global outcome of transplant and quality of life. The repair of this condition was classically made by open repair with mesh. Increasing evidence suggests that laparoscopic repair could be advocated as the technique of choice in these patients with optimal results. However, the fixation of mesh should be performed by a mixed combination of fibrin sealant (lateral margin of wall defect) and tacks (medial margin). The tacks fixation of the mesh along the lateral margin of the wall defect, close to the graft, is generally difficult for the small size of the remaining aponeurotic plane and dangerous for the underlying presence of the graft.
A case of incisional hernia in a kidney transplant recipient was repaired by laparoscopic mesh technique. The polypropylene-polyglycolic acid composite mesh was fastened with a mixed technique of absorbable tacks for medial margin of the defect and fibrin sealant for the lateral side in contiguity with graft surface.
The patient was discharged after 4 days. The 6-month follow-up did not show mesh displacement or recurrence of hernia.
The laparoscopic mesh repair may become the criterion standard for kidney transplant patients affected by incisional hernia. The difficulties of mesh fixation close to the graft can be overcome by the combination of fibrin sealant glue and absorbable tacks at different margins of the wall defect. This technique may offer advantages for this population of patients.
肾移植患者的切口疝是一种会对移植的整体结果和生活质量产生负面影响的并发症。这种病症的修复传统上是通过开放修补并使用补片来进行的。越来越多的证据表明，腹腔镜修补可被推荐为这些患者的首选技术，效果最佳。然而，补片的固定应通过纤维蛋白密封剂（壁缺损的外侧边缘）和钉合（内侧边缘）的混合组合来进行。在靠近移植物的壁缺损外侧边缘处对补片进行钉合固定，由于剩余腱膜平面尺寸小，通常很困难，而且对下方移植物的存在有危险。
一名肾移植受者的切口疝病例通过腹腔镜补片技术进行了修复。聚丙烯 - 聚乙醇酸复合补片采用混合技术固定，缺损内侧边缘使用可吸收钉，与移植物表面相邻的外侧使用纤维蛋白密封剂。
患者术后4天出院。6个月的随访未显示补片移位或疝复发。
腹腔镜补片修补可能成为受切口疝影响的肾移植患者的标准治疗方法。通过在壁缺损的不同边缘联合使用纤维蛋白密封剂胶和可吸收钉，可以克服靠近移植物处补片固定的困难。这种技术可能为这类患者带来优势。
