Causative factors, surgical treatment and outcome of incisional hernia after liver transplantation

• Published in: British journal of surgery Vol. 89; no. 8; pp. 1049 - 1054
• Main Authors: Janßen, H., Lange, R., Erhard, J., Malagó, M., Eigler, F. W., Broelsch, C. E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.08.2002; Wiley
• Subjects: Abdomen; Adult; Aged; Biological and medical sciences; Body Mass Index; Female; Follow-Up Studies; Hernia, Ventral - etiology; Hernia, Ventral - surgery; Humans; Liver Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Postoperative Complications - etiology; Postoperative Complications - surgery; Recurrence; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Human; Surgical incision; Pathogenesis; Liver; Hepatic disease; Transplantation; Homotransplantation; Hernia; Treatment; Abdominal disease; Surgery; Abdominal wall; Digestive diseases; Complication
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1046/j.1365-2168.2002.02165.x

Background: Little is known about the incidence and causes of herniation, and the results of hernia repair in patients undergoing liver transplantation. Likewise, nothing is known about the best surgical approach for hernia repair. Methods: A retrospective analysis was conducted of the occurrence of incisional hernia in 290 patients who had liver transplantation between 1990 and 2000, and survived more than 6 months. Follow‐up data were obtained from medical records and the outpatient service. Patients were evaluated for various clinical and surgical factors. Hernias were analysed with respect to localization, type of surgical repair and recurrence rate. Results: Some 17 per cent of the transplanted patients experienced an incisional hernia. Risk factors were acute rejection with affiliated steroid bolus therapy (P = 0·025), a low platelet count after transplantation (P = 0·048), and a transverse abdominal incision with upper midline approach (P = 0·04). Hernias were mainly located at the junction of the transverse and midline incision (P < 0·001) and the recurrence rate was highest here (P = 0·007). Prosthetic hernia repair achieved the lowest rate of recurrence and did not increase the incidence of infectious complications. Conclusion: Improved immunosuppression should avoid early steroid bolus therapy after transplantation. A low platelet count promotes herniation. Transverse abdominal incision seems to be the best approach for liver transplantation. Prosthetic hernia repair does not increase the complication rate. © 2002 British Journal of Surgery Society Ltd