Utility of a modified components separation for abdominal wall reconstruction in the liver and kidney transplant population

Cara K. Black, Elizabeth G. Zolper, Elliot T. Walters, Jessica Wang, Jesus Martinez, Andrew Tran, Iram Naz, Vikas Kotha, Paul J. Kim, Sarah R. Sher, Karen K. Evans

Research output: Contribution to journalArticle

Abstract

Background Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence. Methods This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay. Results The mean age of patients was 61.0±8.3 years old, with a mean body mass index of 28.4±4.8 kg/m2, 15 males (78.9%), and four females (21.1%). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2%), diabetes (9 patients, 47.4%), and tobacco use (8 patients, 42.1%). Complications occurred in six patients (31.6%) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of 28.7±22.8 months. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days. Conclusions This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.

Original languageEnglish (US)
Pages (from-to)462-469
Number of pages8
JournalArchives of Plastic Surgery
Volume46
Issue number5
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Abdominal Wall
Transplants
Kidney
Liver
Population
Hernia
Recurrence
Liver Transplantation
Kidney Transplantation
Abdominal Hernia
Seroma
Herniorrhaphy
Tobacco Use
Organ Transplantation
Hematoma
Abscess
Comorbidity
Body Mass Index
Hypertension

Keywords

  • Abdominal wall
  • Immunosuppression
  • Incisional hernia
  • Surgical mesh
  • Transplants

ASJC Scopus subject areas

  • Surgery

Cite this

Utility of a modified components separation for abdominal wall reconstruction in the liver and kidney transplant population. / Black, Cara K.; Zolper, Elizabeth G.; Walters, Elliot T.; Wang, Jessica; Martinez, Jesus; Tran, Andrew; Naz, Iram; Kotha, Vikas; Kim, Paul J.; Sher, Sarah R.; Evans, Karen K.

In: Archives of Plastic Surgery, Vol. 46, No. 5, 01.01.2019, p. 462-469.

Research output: Contribution to journalArticle

Black, CK, Zolper, EG, Walters, ET, Wang, J, Martinez, J, Tran, A, Naz, I, Kotha, V, Kim, PJ, Sher, SR & Evans, KK 2019, 'Utility of a modified components separation for abdominal wall reconstruction in the liver and kidney transplant population', Archives of Plastic Surgery, vol. 46, no. 5, pp. 462-469. https://doi.org/10.5999/aps.2018.01361
Black, Cara K. ; Zolper, Elizabeth G. ; Walters, Elliot T. ; Wang, Jessica ; Martinez, Jesus ; Tran, Andrew ; Naz, Iram ; Kotha, Vikas ; Kim, Paul J. ; Sher, Sarah R. ; Evans, Karen K. / Utility of a modified components separation for abdominal wall reconstruction in the liver and kidney transplant population. In: Archives of Plastic Surgery. 2019 ; Vol. 46, No. 5. pp. 462-469.
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abstract = "Background Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence. Methods This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay. Results The mean age of patients was 61.0±8.3 years old, with a mean body mass index of 28.4±4.8 kg/m2, 15 males (78.9{\%}), and four females (21.1{\%}). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2{\%}), diabetes (9 patients, 47.4{\%}), and tobacco use (8 patients, 42.1{\%}). Complications occurred in six patients (31.6{\%}) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of 28.7±22.8 months. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days. Conclusions This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.",
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AU - Zolper, Elizabeth G.

AU - Walters, Elliot T.

AU - Wang, Jessica

AU - Martinez, Jesus

AU - Tran, Andrew

AU - Naz, Iram

AU - Kotha, Vikas

AU - Kim, Paul J.

AU - Sher, Sarah R.

AU - Evans, Karen K.

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N2 - Background Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence. Methods This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay. Results The mean age of patients was 61.0±8.3 years old, with a mean body mass index of 28.4±4.8 kg/m2, 15 males (78.9%), and four females (21.1%). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2%), diabetes (9 patients, 47.4%), and tobacco use (8 patients, 42.1%). Complications occurred in six patients (31.6%) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of 28.7±22.8 months. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days. Conclusions This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.

AB - Background Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence. Methods This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay. Results The mean age of patients was 61.0±8.3 years old, with a mean body mass index of 28.4±4.8 kg/m2, 15 males (78.9%), and four females (21.1%). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2%), diabetes (9 patients, 47.4%), and tobacco use (8 patients, 42.1%). Complications occurred in six patients (31.6%) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of 28.7±22.8 months. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days. Conclusions This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.

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KW - Immunosuppression

KW - Incisional hernia

KW - Surgical mesh

KW - Transplants

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