Gianchandani Rajesh, Pérez Eduardo, Moneva Enrique, Menéndez Alejandro, Sánchez Juan Manuel, Díaz Carmen, Concepción Vanessa, Barrera Manuel Angel
Department of General Surgery and Liver Transplantation, Universitary Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
Department of General Surgery and Liver Transplantation, Universitary Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
Transplant Proc. 2020 Jun;52(5):1514-1517. doi: 10.1016/j.transproceed.2020.01.082. Epub 2020 Apr 4.
Liver transplant (LT) surgery is associated with a high occurrence of hernias, which is related to multiple factors such as body mass index (BMI), diabetes, immunosuppression, corticosteroids, and so on. Laparoscopic ventral hernia repair after LT allows rapid patient recovery with a low postoperative complication rate.
We conducted a retrospective analysis of all LTs performed since 1998 in patients who underwent laparoscopic hernia repair in our centers. Likewise, we reviewed the literature, including all published studies of the laparoscopic approach to hernia repair after LT.
Between 2002 and 2018, 37 patients underwent laparoscopic hernia repair surgery after LT. The majority were men (86%) with a mean age of 51 years (48.5-61) and a BMI of 30.4. All patients underwent laparoscopic surgery, with placement of intraperitoneal mesh with a surface area of 414 cm fixed with nonresorbable tackers. The mean hospital stay was 2 days. Morbidity included 3 seroma (8%) and a wound infection (2%); there was no major morbidity with involvement of the liver graft. The median follow-up was 43 (18-93) months, with 2 cases of recurrence (5%). In the published literature, we found 11 articles, among which the largest series was 54 patients; however, the majority had fewer than 20 cases. In all articles, a decrease in the morbidity and mortality rates was described after this surgery and previous LT decompensation.
Laparoscopic hernia repair in patients with previous LT is safe with a low complication rate and is reproducible and therefore should be the first-choice approach.
肝移植（LT）手术与疝气的高发生率相关，这与多种因素有关，如体重指数（BMI）、糖尿病、免疫抑制、皮质类固醇等。LT术后腹腔镜腹疝修补术可使患者快速康复，术后并发症发生率低。
我们对自1998年以来在我们中心接受腹腔镜疝修补术的所有LT患者进行了回顾性分析。同样，我们回顾了文献，包括所有已发表的关于LT术后腹腔镜疝修补术的研究。
2002年至2018年期间，37例患者在LT术后接受了腹腔镜疝修补手术。大多数为男性（86%），平均年龄51岁（48.5 - 61岁），BMI为30.4。所有患者均接受了腹腔镜手术，使用不可吸收钉固定表面积为414平方厘米的腹膜内补片。平均住院时间为2天。并发症包括3例血清肿（8%）和1例伤口感染（2%）；未发生涉及肝移植的严重并发症。中位随访时间为43（18 - 93）个月，有2例复发（5%）。在已发表的文献中，我们发现11篇文章，其中最大的系列为54例患者；然而，大多数文章的病例数少于20例。在所有文章中，均描述了该手术及先前LT失代偿后发病率和死亡率的降低。
既往LT患者的腹腔镜疝修补术安全，并发症发生率低，且可重复，因此应作为首选方法。
