A. Wiley1, S. Ayuso1, S. Elhage1, G. Scarola1, B.T. Heniford1, V. Augenstein1 1Atrium Health – Carolinas Medical Center, Gastrointestinal And Minimally Invasive Surgery, Charlotte, NORTH CAROLINA, USA
Introduction: Patients with a history of orthotopic liver transplant (OLT) are often comorbid and frequently develop complicated hernias. This study aimed to evaluate optimal management in AWR in these complex patients.
Methods: A prospectively maintained, IRB-approved database including patients undergoing open, preperitoneal ventral hernia repair (OVHR) after OLT was evaluated. Patient characteristics, operative details, and perioperative outcomes were reported.
Results: A total of 28 liver transplant patients undergoing OVHR met the prescribed criteria. The average age was 59.9±11.1 years, and mean BMI was 30.4±4.5. Of these patients, 42.9% had diabetes, 42.9% had CKD, and 39.2% had history of tobacco use. All patients were immunosuppressed and received either Tacrolimus only (60.7%), a combination of tacrolimus and mycophenolate mofetil (32.1%) or cyclosporine (7.1%), and 21.4% had a history of steroid use. Amongst these patients, 14.3% stopped sirolimus or everolimus preoperatively. All patients had normal graft function preoperatively. Average defect size was large at 309.3±87.2cm2, and five (17.9%) patients received preoperative botulinum toxin A injection into their obliques musculature due to significant loss of domain. Average mesh size was 800.0±214.3cm2. Fascia was closed in all patients. Two (7.1%) patients required component separation techniques, including one anterior and one posterior component separation technique. Postoperatively, two patients (7.1%) developed a seroma requiring intervention and one (3.6%) developed wound infection, accounting for one (3.6%) 30-day re-admissions. There was one hernia recurrence (3.6%). There were no mesh infections. Mean follow-up time was 40.4±24.0 months.
Conclusion: Preperitoneal biologic mesh is an effective strategy for management of incisional hernia within orthotopic liver transplant patients with low rate of recurrence, wound infection and no mesh infections. Perioperative optimization, perioperative management and careful mesh selection are important in pursuing promising outcomes for these complex patients.