Division of Transplantation, Department of Surgery, Washington University in St Louis, USA.
Division of Transplantation, Department of Surgery, Washington University in St Louis, USA.
Int J Surg. 2020 Jun;78:149-153. doi: 10.1016/j.ijsu.2020.04.048. Epub 2020 Apr 23.
Incisional hernias (IH) develop in up to 40% of liver transplant (LT) recipients and can contribute to considerable morbidity.
A single center retrospective review of a prospectively maintained LT database was conducted to identify all patients diagnosed with IH after LT during a 13-year study period (2003-2015). Analyzed data included patient demographics, LT details, incidence and timing of IH, risk factors, management strategies and long-term outcomes.
During the 13-year study period, IH was diagnosed in 16.7% (163/976) of LT recipients after a median of 19.6 months (range 6.7-49.5 months) from transplant surgery. Identified risk factors for developing IH included male gender (p < 0.001) while acute cellular rejection (ACR) was found to be negatively associated with the risk of developing IH (p = 0.014). Acute incarceration/strangulation was seen in 4 patients with IH while the remaining (n = 159) presented with non-emergent symptoms. Surgical repair was undertaken in 70/163 (43%) IH patients after medical optimization when possible (open repair 83%, mesh use 90%). IH recurrence rate was 14.3% (10/70) with comparable rates in no-mesh and with-mesh repairs (42.9% vs. 11.3%; p = 0.057) and open (15.8%) and laparoscopic (9.1%) approaches (p = 0.68).
IH is a late complication following LT and male gender is a consistent predictive marker. Acute presentation is infrequent and elective repair can be planned in most patients allowing for risk factor optimization to ensure promising long-term outcomes.
切口疝（IH）在多达 40%的肝移植（LT）受者中发生，可导致相当大的发病率。
对一个前瞻性维护的 LT 数据库进行了单中心回顾性研究，以确定在 13 年的研究期间（2003-2015 年）诊断为 LT 后 IH 的所有患者。分析的数据包括患者的人口统计学资料、LT 细节、IH 的发生率和时间、危险因素、管理策略和长期结果。
在 13 年的研究期间，163/976（16.7%）例 LT 受者在移植手术后中位数为 19.6 个月（范围 6.7-49.5 个月）后诊断为 IH。发生 IH 的危险因素包括男性（p<0.001），而急性细胞排斥（ACR）与 IH 的发生风险呈负相关（p=0.014）。4 例 IH 患者出现急性嵌顿/绞窄，而其余（n=159）例患者表现为非紧急症状。在可能的情况下（开放修复 83%，使用网片 90%），对 70/163（43%）例 IH 患者进行了医学优化后的手术修复。IH 复发率为 10/70（14.3%），无网片和有网片修复的复发率相似（42.9%与 11.3%；p=0.057），开放（15.8%）和腹腔镜（9.1%）方法的复发率也相似（p=0.68）。
IH 是 LT 后的晚期并发症，男性是一致的预测标志物。急性表现并不常见，大多数患者可计划进行择期修复，从而可以优化危险因素，以确保有良好的长期结果。
