Black Cara K, Zolper Elizabeth G, Walters Elliot T, Wang Jessica, Martinez Jesus, Tran Andrew, Naz Iram, Kotha Vikas, Kim Paul J, Sher Sarah R, Evans Karen K
Georgetown University School of Medicine, Washington, DC, USA.
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Arch Plast Surg. 2019 Sep;46(5):462-469. doi: 10.5999/aps.2018.01361. Epub 2019 Sep 15.
Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence.
This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay.
The mean age of patients was 61.0±8.3 years old, with a mean body mass index of 28.4±4.8 kg/m2, 15 males (78.9%), and four females (21.1%). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2%), diabetes (9 patients, 47.4%), and tobacco use (8 patients, 42.1%). Complications occurred in six patients (31.6%) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of 28.7±22.8 months. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days.
This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.
切口疝是内脏器官移植后的常见并发症。由于长期免疫抑制和大切口，移植患者发生原发性和复发性疝的风险增加。我们对有肝或肾移植病史且接受疝修补术的患者进行了回顾性研究，以分析手术结果和疝复发情况。
这是一项单中心回顾性研究，研究对象为2011年至2017年间在出现切口疝之前接受过肾和/或肝移植的19例患者。所有疝均采用开放成分分离技术（CST）并使用生物补片进行修补。
患者的平均年龄为61.0±8.3岁，平均体重指数为28.4±4.8kg/m²，男性15例（78.9%），女性4例（21.1%）。其中肾移植患者7例，肝移植患者11例，肝肾联合移植患者1例。最常见的合并症为高血压（16例，84.2%）、糖尿病（9例，47.4%）和吸烟（8例，42.1%）。6例患者（31.6%）出现并发症，包括血肿（1/19）、脓肿（1/19）、血清肿（2/19）和疝复发（3/19），平均随访时间为28.7±22.8个月。除2例随访不完整的患者外，所有患者均在27天的中位时间愈合。
这项针对移植患者的小型回顾性复杂开放CST系列研究显示，长期疝复发率和愈合率均可接受。通过采用多学科方法进行腹壁重建，我们认为改良开放CST联合生物补片是治疗复杂腹疝移植患者的一种安全有效的技术。
