Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Clin Transplant. 2023 Jun;37(6):e14969. doi: 10.1111/ctr.14969. Epub 2023 Mar 28.
Incisional hernia is a common complication following liver transplantation occurring in 5%-34% of patients. Traditionally, open repair was standard due to fear of abdominal adhesions, postoperative complications and lack of experience with laparoscopic techniques. Laparoscopic incisional hernia repair (LIHR) has now become routine in non-transplant patients, with improved postoperative outcomes. In this study, we compared outcomes after laparoscopic and open incisional hernia repair after liver transplantation at a high-volume liver transplant center.
We performed a retrospective cohort study including all incisional hernia repairs performed on post-liver transplant patients at a major liver transplant center in Australia from 2010 to 2021. Donor, recipient, intraoperative and postoperative variables were collected from the electronic medical record focusing on laparoscopic and open repairs.
Between January 2010 and March 2021, 138 patients underwent incisional hernia repair: 40 laparoscopic (29%) and 98 open (71%). No difference in wound infection (2.5% vs. 7.7%, p = .243); wound dehiscence (.00% vs. 2.3%, p = .332) or hernia recurrence (16.3% vs. 23.0%, p = .352) was seen between treatment groups. For larger incisional hernias (>5 cm) we found that a laparoscopic repair reduced length of stay compared to open-repair (3.89 vs. 4.57 days, p = .026).
Laparoscopic repair of larger incisional hernias reduced postoperative length of hospital stay, whilst potential advantages may include reduced wound complications and hernia recurrence. Importantly, laparoscopic repair did not increase postoperative complication rates and represents a safe technique for repair in this demographic.
切口疝是肝移植术后的一种常见并发症，发生率为 5%-34%。传统上，由于担心腹部粘连、术后并发症和缺乏腹腔镜技术经验，开放修复是标准方法。腹腔镜切口疝修补术（LIHR）现在已成为非移植患者的常规手术，术后结果得到改善。在这项研究中，我们比较了在高容量肝移植中心，肝移植后行腹腔镜和开放切口疝修补术的结果。
我们进行了一项回顾性队列研究，纳入了 2010 年至 2021 年期间在澳大利亚一家主要肝移植中心接受肝移植后行切口疝修补术的所有患者。从电子病历中收集供体、受体、术中及术后变量，重点关注腹腔镜和开放修复。
2010 年 1 月至 2021 年 3 月，共有 138 例患者行切口疝修补术：40 例腹腔镜（29%），98 例开放（71%）。两组在伤口感染（2.5%比 7.7%，p=0.243）、伤口裂开（0.00%比 2.3%，p=0.332）或疝复发（16.3%比 23.0%，p=0.352）方面无差异。对于较大的切口疝（>5cm），我们发现腹腔镜修复术较开放修复术缩短了住院时间（3.89 比 4.57 天，p=0.026）。
腹腔镜治疗较大的切口疝可减少术后住院时间，潜在的优势可能包括减少伤口并发症和疝复发。重要的是，腹腔镜修复术并未增加术后并发症发生率，代表了该人群安全的手术技术。
