From the Department of Transplantation, Baskent University, Ankara, Turkey.
Exp Clin Transplant. 2020 Jan;18(Suppl 1):32-35. doi: 10.6002/ect.TOND-TDTD2019.O6.
Primary abdominal wound closure is performed at the completion of liver transplant in most patients. However, this is not always possible in pediatric recipients. The shortage of size-matched donor organs for pediatric patients means that occasionally it is necessary to use whole livers that are larger than can be accommodated comfortably in the child's abdomen. The present report outlines our experience with temporary patch closure after pediatric liver transplant of the abdominal wall.
Our team performed the first liver transplant in Turkey in 1988. Since 1988, we have performed 629 liver transplant (336 adult and 293 pediatric) procedures at our center. We evaluated data of 191 liver transplants performed in recipients who were under 10 years of age. Left lateral lobe grafts were used in 169 patients (88%), and whole grafts were used in 22 patients (12%).
Temporary closure with the Bogota bag patch was necessary in 31 transplant procedures (16.2%), 3 of which involved whole livers and 28 of which involved left lateral lobe grafts. The age range of recipients was 5 months to 10 years (median, 30 mo). The temporary abdominal closure technique was preferred in 22 patients because the abdomen could not be closed during surgery.
In pediatric patients with difficult abdominal closure after liver transplant, temporary patch closure is the treatment of choice. Our preference has been reinforced silicone sheeting, which allows minimal adhesion formation between the patch and abdominal viscera; in addition, the transparent nature of the material provides a window for inspection of the donor liver.
在大多数患者中，肝移植完成时会进行原发性腹部伤口闭合。然而，在儿科受者中并非总是如此。儿科患者的供体器官大小匹配不足，意味着偶尔需要使用超出儿童腹部舒适容纳范围的整个肝脏。本报告概述了我们在小儿肝移植后进行腹壁临时补丁闭合的经验。
我们的团队于 1988 年在土耳其进行了首例肝移植。自 1988 年以来，我们在中心进行了 629 例肝移植（336 例成人和 293 例儿科）手术。我们评估了在 10 岁以下受者中进行的 191 例肝移植的数据。169 例患者（88%）使用了左外侧叶移植物，22 例患者（12%）使用了整个移植物。
31 例移植手术（16.2%）需要进行 Bogota 袋补丁的临时关闭，其中 3 例涉及整个肝脏，28 例涉及左外侧叶移植物。受者的年龄范围为 5 个月至 10 岁（中位数为 30 个月）。在 22 例患者中，首选临时腹部闭合技术，因为在手术过程中无法关闭腹部。
在肝移植后腹部难以闭合的小儿患者中，临时补丁闭合是首选治疗方法。我们的偏好一直是强化硅酮片，它可以最大限度地减少补丁和腹部内脏之间的粘连形成；此外，材料的透明性质提供了一个检查供体肝脏的窗口。
