S. Kurapati1,2, B. D. Denney1, J. I. De La Torre1,2 1University of Alabama at Birmingham,Plastic Surgery,Birmingham, AL, USA 2Birmingham V.A. Medical Center,Plastic Surgery,Birmingham, AL, USA
Introduction: Component separation has been established as an effective technique for complex abdominal wall reconstruction. However, incisional hernias following orthotopic liver transplantation (OLT) presents a particular challenge. This patient population which is immune suppressed often has pre-existing incisions that present a challenge for reconstruction.
Methods: The records of 183 patients who underwent complex abdominal wall reconstruction since 2010 were reviewed and used as our control. Within this group, patients were identified by CPT codes for a history of both component separation and liver transplantation. Data reviewed included patient demographics and comorbidities, concomitant procedures, and characteristics of the reconstruction such as surgical incision. Primary data endpoints were complications following surgery, including recurrence.
Results: The study group consisted of 9 patients, 8 who were OLT recipients and a single patient who was a partial liver donor. In the study group, there were no hernia recurrences. Primary myofacial continuiuty was achieved in 100% of the patients. A chevron incision was used in 66% of cases and biologic material was used in 78%. Overall morbidity was 11%, with one patient identified with deep venous thrombosis. There were no significant wound healing problems. For comparison, in the control group, the recurrence rate was 7% and primary approximation of the fascial defect was achieved in 92% of the patients. Significant complications occurred in 17%.
Conclusion: Modified abdominal wall reconstruction with component separation with or without onlay biologic mesh is a reliable approach to address hernia defects in patients who have had incisions associated with liver transplants, including those on ongoing immunosuppression. With appropriate care, this patient group has no increase in adverse outcomes compared to those patients who do not have the pre-existing surgical scars and immunosuppression.
