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Broering DC, Elsheikh Y, Malago M, Alnemary Y, Alabbad S, Boehnert MU, Raptis DA. Outcomes of Fully Robotic Recipient Living Donor Liver Transplant in Relation to the Open Approach. Transplantation 2024; 108:2396-2402. [PMID: 38872242 DOI: 10.1097/tp.0000000000005109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND Over the past 20 y, robotic surgery has entered nearly all surgical disciplines, aiming to improve patient outcomes. Liver transplantation has evolved with these advancements, and fully robotic liver transplants represent the latest innovation in this field. This study reports on the world's first series of fully robotic recipient liver transplants from robotic living donors, comparing them with matched cases from the standard open transplant approach. METHODS A case-control study was conducted at our center from August to December 2023. Patient selection criteria for robotic recipient liver transplantation included a Model for End-stage Liver Disease score of ≤25, specific anatomical characteristics, and logistics. A propensity score analysis with a 1:4 matching ratio was used. RESULTS The study analyzed 10 fully robotic living donor and robotic recipient liver transplant pairs with a median donor age of 29 y and a recipient age of 61 y. The main indication for transplantation was nonalcoholic steatohepatitis (6/10). There was 1 robotic to open conversion, and the median operation time was 10 h, with a median hospital stay of 13 d, shorter than the 18 d in the open group. Three recipients experienced a complication, and there was no mortality. CONCLUSIONS The first-ever series of fully robotic living donor recipient liver transplants showed encouraging initial results with a markedly reduced hospital stay. The ultimate goal is to refine the technique to offer robotic liver transplants to the majority of recipients, overcoming the current selection criteria. Further research and a planned randomized controlled trial will aim to confirm these results.
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Affiliation(s)
- Dieter C Broering
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Justo I, Caso O, Marcacuzco A, Rodríguez-Gil Y, Jiménez-Romero C. Hernia Correction After Liver Transplantation Using Nonvascularized Fascia. Transplant Direct 2024; 10:e1662. [PMID: 38911273 PMCID: PMC11191961 DOI: 10.1097/txd.0000000000001662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 06/25/2024] Open
Abstract
Background Liver transplantation is an increasingly frequent surgical procedure, with elevated rates of postoperative incisional hernias ranging from 5% to 46%. There are numerous known risk factors for incisional hernia, including the type of incision, patient sex, and presence of comorbidities such as diabetes, ascites, older age, and the use of steroids. Most studies on the treatment of incisional hernias in patients who have undergone liver transplantation have shown consistently high rates of complications. Consequently, we propose the use of nonvascular fascia for the symptomatic treatment of incisional hernias in patients with concomitant liver transplantation. Methods We performed our new technique on 8 patients, who had previously undergone liver transplantation, between January 2019 and January 2023. The patients were examined using imaging techniques during the follow-up period. Results Of the 8 patients, 7 were liver transplant recipients and 1 was a combined liver-kidney transplant patient. The median donor age was 57 y (5-66 y), whereas the mean recipient age was 58 y (31-66 y). The median patient height and weight were 163 cm (117-185 cm) and 76 kg (17-104 kg), respectively. Immunosuppression did not change in fascia recipients. The median time between transplantation and hernia repair surgery was 41 mo (5-116 mo). The sizes of the aponeurotic defects varied from 6 × 6 to 25 × 20 cm. Two patients experienced complications: one experienced bulging that required reintervention and the other experienced surgical site seroma. There was no mortality related to the use of the technique, and none were reported during follow-up. Conclusions With its promising results, nonvascularized fascial transplantation can be a successful treatment for incisional hernias in patients who had previously received a liver transplant.
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Affiliation(s)
- Iago Justo
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Oscar Caso
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Alberto Marcacuzco
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Yolanda Rodríguez-Gil
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Carlos Jiménez-Romero
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Instituto de Investigación (imas12), Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
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Kanella I, Kengadaran K, Papalois V. Management of incisional hernias in renal transplant patients. TRANSPLANTATION REPORTS 2023; 8:100148. [DOI: 10.1016/j.tpr.2023.100148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2025] Open
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Simforoosh N, Nayebzade A, Dadpour M, Rohani S. Corticosteroid Dose in Kidney Transplantation and Its Effect on Surgical Complication: A Systematic Review. EXP CLIN TRANSPLANT 2023; 21:631-638. [PMID: 37698397 DOI: 10.6002/ect.2023.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVES Although several studies have explored the connection between corticosteroids and renal transplant surgical complications, these studies have overlooked several factors. In addition, no review of the literature, to our knowledge, has been conducted to evaluate corticosteroid dose and incidence of posttransplant surgical complications in these patients. Thus, our objective was to carry out a systematic investigation ofthe correlationbetween corticosteroids and surgical complications in renaltransplant patients. MATERIALS AND METHODS A systematic search was conducted on the PubMed and Embase databases from their inception until April 2023. Retrospective and prospective cohort studies were included if they met the association between corticosteroids and surgical complications. The search strategy was performed using MeSH and non-MeSH key words. Terms used in the electronic search included kidney transplant* OR kidney transplant(mesh) AND steroid* OR steroids(mesh) AND complication* OR intraoperative complications(mesh). RESULTS From 3274 articles, 8 articles were included in the systematic review. Six studies were conducted as retrospective cohorts and 2 studies as prospective cohorts. The mean age of patients included in the studies was 42.1 years. The studies were conducted between 1981 and 2023. Findings suggested that decreasing the postoperative corticosteroid dosage was associated with a lower incidence of various postoperative surgical complications. CONCLUSIONS We investigated the potential benefits of reducing the dose of corticosteroids following kidney transplant. Findings suggested thatreducing the dose of corticosteroids following kidney transplant might be a viable strategy for minimizing the risk of surgical complications. However, it is essential to note that the optimal dosage and duration of corticosteroid therapy after kidney transplant may vary for each patient and should be carefully determined by the health care provider.
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Affiliation(s)
- Nasser Simforoosh
- >From the Shahid Labbafinejad Medical Center, Center of Excellence in Urology, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
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Mao Y, Xi L, Lu C, Miao J, Li Q, Shen X, Yu C. Incidence, risk factors, and predictive modeling of stoma site incisional hernia after enterostomy closure: a multicenter retrospective cohort study. BMC Gastroenterol 2023; 23:201. [PMID: 37296427 DOI: 10.1186/s12876-023-02805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Stoma site incisional hernia (SSIH) is a common complication, but its incidence and risk factors are not well known. The objective of this study is to explore the incidence and risk factors of SSIH and build a predictive model. METHODS We performed a multicenter retrospective analysis on the patients who underwent enterostomy closure from January 2018 to August 2020. Patient's general condition, perioperative, intraoperative, and follow-up information was collected. The patients were divided into control group (no occurrence) and observation group (occurrence) according to whether SSIH occurred. Univariate and multivariate analysis were used to evaluate the risk factors of SSIH, following which we constructed a nomogram for SSIH prediction. RESULTS One hundred fifty-six patients were enrolled in the study. The incidence of SSIH was 24.4% (38 cases), of which 14 were treated with hernia mesh repair, and the others were treated with conservative treatment. Univariate and multivariate analysis showed that age ≥ 68 years (OR 1.045, 95% CI 1.002 ~ 1.089, P = 0.038), colostomy (OR 2.913, 95% CI 1.035 ~ 8.202, P = 0.043), BMI ≥ 25 kg/m2 (OR 1.181, 95% CI 1.010 ~ 1.382, P = 0.037), malignant tumor (OR 4.838, 95% CI 1.508 ~ 15.517, P = 0.008) and emergency surgery (OR 5.327, 95% CI 1.996 ~ 14.434, P = 0.001) are the independent risk factors for SSIH. CONCLUSIONS Based on the results, a predictive model for the occurrence of SSIH was constructed to screen high-risk groups of SSIH. For patients at high risk for SSIH, how to deal with the follow-up and prevent the occurrence of SSIH is worth further exploration.
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Affiliation(s)
- Yonghuan Mao
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ling Xi
- Department of Gerontology, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Lu
- Department of General Surgery, Sir Run Run Hospital of Nanjing Medical University, Nanjing, China
| | - Ji Miao
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Qiang Li
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Xiaofei Shen
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Chunzhao Yu
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
- Department of General Surgery, Sir Run Run Hospital of Nanjing Medical University, Nanjing, China.
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Soto E, Zoog E, Nolte MD, Fang HA, de la Torre JI. Outcomes of Ventral Hernia Repair After Orthotopic Liver Transplant Using Component Separation and Onlay Biologic Mesh. Ann Plast Surg 2023; 90:S387-S390. [PMID: 36921332 PMCID: PMC10290573 DOI: 10.1097/sap.0000000000003340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
INTRODUCTION The management of ventral hernias (VHs) after orthotopic liver transplant (OLT) can be uniquely challenging because of immunosuppression coupled with large laparotomy size that can compromise the quality of the abdominal wall. The component separation with multipoint suture onlay acellular dermis fixation technique has proven to be effective in high-risk abdominal wall reconstructions. The goal of this study was to elucidate the factors that affect safety and efficacy of VH repair in post-OLT patients. METHODS A retrospective review of 345 patients who underwent repair of VH with compartment separation and onlay acellular dermal matrix reinforcement from a single surgeon from 2012 to 2020 was conducted. Of these, 27 patients were identified with a history of OLT and were stratified based on whether the defect was a initial or recurrent hernia repair. The majority of patients had a standard chevron incision (70%). Data abstraction was performed for preoperative risk factors, hernia characteristics, surgical site complications, and postoperative course including hernia recurrence. RESULTS A majority of cases in the study period were initial hernia repairs (59%) with no significant differences in the patient demographics and size of VH defects (190 ± 112.69 cm 2 ). Comorbidities were similar between the groups with the exception of a significantly higher baseline creatinine levels and higher history of smoking in the recurrent hernia repair group ( P < 0.05). Of the 27 cases, there were no demonstrable hernia recurrences noted and an overall 11% complication rate. Univariate analysis noted a statistically significant difference in surgical site complication rate ( P = 0.017), with the initial hernia repair group having the lowest rate of surgical site complications. CONCLUSIONS In complex post-OLT patients with large VH, modified component separation with onlay acellular mesh was shown to have acceptable medium-term results. Further studies investigating the factors leading to postoperative complications are necessary to reduce recurrence in this evolving patient population.
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Pereira-Rodríguez JA, Bravo-Salva A, Argudo-Aguirre N, Amador-Gil S, Pera-Román M. Defining High-Risk Patients Suitable for Incisional Hernia Prevention. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:10899. [PMID: 38312422 PMCID: PMC10831640 DOI: 10.3389/jaws.2023.10899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/19/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Jose Antonio Pereira-Rodríguez
- General and Digestive Surgery Department, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Alejandro Bravo-Salva
- General and Digestive Surgery Department, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Núria Argudo-Aguirre
- General and Digestive Surgery Department, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Sara Amador-Gil
- General and Digestive Surgery Department, Hospital de Granollers, Granollers, Spain
| | - Miguel Pera-Román
- General and Digestive Surgery Department, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
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Feng Z, Wang SP, Wang HH, Lu Q, Qiao W, Wang KL, Ding HF, Wang Y, Wang RF, Shi AH, Ren BY, Jiang YN, He B, Yu JW, Wu RQ, Lv Y. Magnetic-assisted laparoscopic liver transplantation in swine. Hepatobiliary Pancreat Dis Int 2022; 21:340-346. [PMID: 35022144 DOI: 10.1016/j.hbpd.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/22/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although laparoscopic technology has achieved rapid development in the surgical field, it has not been applied to liver transplantation, primarily because of difficulties associated with laparoscopic vascular anastomosis. In this study, we introduced a new magnetic-assisted vascular anastomosis technique and explored its application in laparoscopic liver transplantation in pigs. METHODS Two sets of magnetic vascular anastomosis rings (MVARs) with different diameters were developed. One set was used for anastomosis of the suprahepatic vena cava (SHVC) and the other set was used for anastomosis of the infrahepatic vena cava (IHVC) and portal vein (PV). Six laparoscopic orthotopic liver transplantations were performed in pigs. Donor liver was obtained via open surgery. Hepatectomy was performed in the recipients through laparoscopic surgery. Anastomosis of the SHVC was performed using hand-assisted magnetic anastomosis, and the anastomosis of the IHVC and PV was performed by magnetic anastomosis with or without hand assistance. RESULTS Liver transplants were successfully performed in five of the six cases. Postoperative ultrasonographic examination showed that the portal inflow was smooth. However, PV bending and blood flow obstruction occurred in one case because the MVARs were attached to each other. The durations of loading of MVAR in the laparoscope group and manual assistance group for IHVC and PV were 13 ± 5 vs. 5 ± 1 min (P < 0.01) and 10 ± 2 vs. 4 ± 1 min (P < 0.05), respectively. The durations of MVAR anastomosis in the laparoscope group and manual assistance group for IHVC and PV were 5 ± 1 vs. 1 ± 1 min (P < 0.01), and 5 ± 1 vs. 1 ± 1 min (P < 0.01), respectively. The anhepatic phase was 43 ± 4 min in the laparoscope group and 23 ± 2 min in the manual assistance group (P < 0.01). CONCLUSIONS Our study showed that magnetic-assisted laparoscopic liver transplantation can be successfully carried out in pigs.
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Affiliation(s)
- Zhe Feng
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Shan-Pei Wang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Hao-Hua Wang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Qiang Lu
- Department of Geriatric Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Wei Qiao
- Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an 710000, China
| | - Kai-Ling Wang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Hong-Fan Ding
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yue Wang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Rong-Feng Wang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Ai-Hua Shi
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Bing-Yi Ren
- Zonglian College, Xi'an Jiaotong University, Xi'an 710000, China
| | - Yu-Nan Jiang
- Zonglian College, Xi'an Jiaotong University, Xi'an 710000, China
| | - Bin He
- Zonglian College, Xi'an Jiaotong University, Xi'an 710000, China
| | - Jia-Wei Yu
- Zonglian College, Xi'an Jiaotong University, Xi'an 710000, China
| | - Rong-Qian Wu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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Nashan B, Schemmer P, Braun F, Schlitt HJ, Pascher A, Klein CG, Neumann UP, Kroeger I, Wimmer P. Early Everolimus-Facilitated Reduced Tacrolimus in Liver Transplantation: Results From the Randomized HEPHAISTOS Trial. Liver Transpl 2022; 28:998-1010. [PMID: 34525259 PMCID: PMC9291476 DOI: 10.1002/lt.26298] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/05/2021] [Accepted: 09/08/2021] [Indexed: 12/13/2022]
Abstract
Everolimus-facilitated reduced-exposure tacrolimus (EVR + rTAC) at 30 days after liver transplantation (LT) has shown advantages in renal preservation. This study evaluated the effects of early initiation of EVR + rTAC in de novo LT recipients (LTRs). In HEPHAISTOS (NCT01551212, EudraCT 2011-003118-17), a 12-month, multicenter, controlled study, LTRs were randomly assigned at 7 to 21 days after LT to receive EVR + rTAC or standard-exposure tacrolimus (sTAC) with steroids. The primary objective was to demonstrate superior renal function (assessed by estimated glomerular filtration rate [eGFR]) with EVR + rTAC versus sTAC at month 12 in the full analysis set (FAS). Other assessments at month 12 included the evaluation of renal function in compliance set and on-treatment (OT) patients, efficacy (composite endpoint of graft loss, death, or treated biopsy-proven acute rejection [tBPAR] and individual components) in FAS, and safety. In total, 333 patients (EVR + rTAC, 169; sTAC, 164) were included in the FAS. A high proportion of patients was nonadherent in maintaining tacrolimus trough levels (EVR + rTAC, 36.1%; sTAC, 34.7%). At month 12, the adjusted least square mean eGFR was numerically higher with EVR + rTAC versus sTAC (76.2 versus 72.1 mL/minute/1.73 m2 , difference: 4.1 mL/minute/1.73 m2 ; P = 0.097). A significant difference of 8.3 mL/minute/1.73 m2 (P = 0.03) favoring EVR + rTAC was noted in the compliance set. Incidence of composite efficacy endpoint (7.7% versus 7.9%) and tBPAR (7.1% versus 5.5%) at month 12 as well as incidence of treatment-emergent adverse events (AEs) and serious AEs were comparable between groups. A lower proportion of patients discontinued EVR + rTAC than sTAC treatment (27.2% versus 34.1%). Early use of everolimus in combination with rTAC showed comparable efficacy, safety, and well-preserved renal function versus sTAC therapy at month 12. Of note, renal function was significantly enhanced in the compliance set.
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Affiliation(s)
- Björn Nashan
- Department of Hepatobiliary Surgery and Visceral TransplantationUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Present address:
Organ Transplantation CenterThe First Affiliated Hospital of University of Science and Technology of ChinaAnhui Provincial HospitalHefeiChina
| | - Peter Schemmer
- Department of General, Visceral and Transplant SurgeryUniversity Hospital HeidelbergHeidelbergGermany
- Present address:
General, Visceral and Transplant SurgeryDepartment of SurgeryMedical University of GrazGrazAustria
| | - Felix Braun
- Department of General, Visceral, Thoracic, Transplant and Pediatric SurgeryUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Hans J. Schlitt
- Department of SurgeryUniversity Hospital RegensburgRegensburgGermany
| | - Andreas Pascher
- Department of General, Visceral and Transplant SurgeryCharité–Universitätsmedizin BerlinBerlinGermany
- Present address:
Department of General, Visceral and Transplantation SurgeryUniversity Hospital MünsterMünsterGermany
| | - Christian G. Klein
- Department of General, Visceral and Transplantation SurgeryUniversity Hospital EssenEssenGermany
| | - Ulf P. Neumann
- Department of General, Visceral and Transplant SurgeryUniversity Hospital AachenAachenGermany
- Present address:
Department of GeneralVisceral and Transplant SurgeryUniversity Hospital AachenAachenGermany
- Present address:
Department of General SurgeryMaastricht University Medical Centre (MUMC)Maastrichtthe Netherlands
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Alhassan AM, Alghunaim MN, Alqarni AA, Abdullah AM, Altoyan MK, Alharbi AS, Alhusain FA. Incidence Rate of Incisional Hernia Post Liver and Kidney Transplant at a Tertiary Center in Riyadh, Saudi Arabia. Cureus 2021; 13:e20223. [PMID: 34909349 PMCID: PMC8653929 DOI: 10.7759/cureus.20223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 12/07/2022] Open
Abstract
Background Incisional hernia post organ transplant increases morbidity and impacts quality of life among patients undergoing abdominal organ transplants. Objectives To estimate the incidence rate of incisional hernia and the factors associated with incisional hernia among patients who underwent liver and kidney transplants. Methods This was a retrospective cohort study in which all patients from 2015 to 2020 who underwent liver and/or kidney transplants and met inclusion criteria were involved. Results A total of 424 patients who received transplantation surgery were included. Out of them, 287 patients (67.6%) underwent kidney transplants while 132 patients (31.1%) underwent a liver transplant. Additionally, five patients (1.1%) received both liver and kidney transplantation. Fourteen patients (3.3%) experienced incisional hernia across all samples. A higher incidence rate was noticed among patients with liver transplants compared to kidney transplants (6.81% in the liver group vs 1.7% in the kidney group), which showed a statistical significance between the two groups (P-value= 0.007). In multivariate analysis, surgical site infection (SSI), donor type, acute organ rejection, mycophenolate mofetil (MMF), and diabetes were all not predictors of incisional hernia among the patients. Conclusion Incisional hernia incidence in between the groups was within the global range of incisional hernia incidence among abdominal organ transplant patients, with a higher incidence among liver transplant patients. All factors associated with incisional hernia, such as SSI, DM, and old age, didn’t show significance as predictors to incisional hernia formation among the samples.
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Affiliation(s)
| | - Mohammed N Alghunaim
- General Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | - Ayyob A Alqarni
- General Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | | | - Mohammed K Altoyan
- Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
| | - Abdullah S Alharbi
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Faisal A Alhusain
- Emergency Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, SAU
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Dashti-Khavidaki S, Saidi R, Lu H. Current status of glucocorticoid usage in solid organ transplantation. World J Transplant 2021; 11:443-465. [PMID: 34868896 PMCID: PMC8603633 DOI: 10.5500/wjt.v11.i11.443] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/16/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023] Open
Abstract
Glucocorticoids (GCs) have been the mainstay of immunosuppressive therapy in solid organ transplantation (SOT) for decades, due to their potent effects on innate immunity and tissue protective effects. However, some SOT centers are reluctant to administer GCs long-term because of the various related side effects. This review summarizes the advantages and disadvantages of GCs in SOT. PubMed and Scopus databases were searched from 2011 to April 2021 using search syntaxes covering “transplantation” and “glucocorticoids”. GCs are used in transplant recipients, transplant donors, and organ perfusate solution to improve transplant outcomes. In SOT recipients, GCs are administered as induction and maintenance immunosuppressive therapy. GCs are also the cornerstone to treat acute antibody- and T-cell-mediated rejections. Addition of GCs to organ perfusate solution and pretreatment of transplant donors with GCs are recommended by some guidelines and protocols, to reduce ischemia-reperfusion injury peri-transplant. GCs with low bioavailability and high potency for GC receptors, such as budesonide, nanoparticle-mediated targeted delivery of GCs to specific organs, and combination use of dexamethasone with inducers of immune-regulatory cells, are new methods of GC application in SOT patients to reduce side effects or induce immune-tolerance instead of immunosuppression. Various side effects involving different non-targeted organs/tissues, such as bone, cardiovascular, neuromuscular, skin and gastrointestinal tract, have been noted for GCs. There are also potential drug-drug interactions for GCs in SOT patients.
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Affiliation(s)
- Simin Dashti-Khavidaki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14155, Iran
| | - Reza Saidi
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Hong Lu
- Department of Pharmacology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
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Zarbaliyev E, Sevmiş M, Kilercik H, Çelik S, Aktaş S, Çağlıkülekçi M, Sevmiş Ş. Is the incision type important for the development of hernia in liver transplant patients? Clin Transplant 2021; 36:e14497. [PMID: 34591336 DOI: 10.1111/ctr.14497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/04/2021] [Accepted: 09/25/2021] [Indexed: 12/07/2022]
Abstract
OBJECTIVE In this study, we aimed to investigate the rates and causes of incisional hernia that developed in the postoperative follow-up of patients who underwent liver transplantation. MATERIAL AND METHOD The results of patients who underwent LT by using three different incisions at the İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital organ transplant center between January 2015 and December 2019 were retrospectively analyzed. Patients were divided into Chevron (group-1), reverse T (group-2), and J incisions (group-3) and hernia development rates were examined. RESULTS There was no significant difference in terms of incisional hernia in groups 1 and 2 according to the incision type (p = .723). Incisional hernia rate was significantly lower in the J incision group (p < .001). When the factors that increase the development of hernia in all LT patients were examined, it was seen that male gender (p = .021), high BMI rate (p = .003), postoperative bleeding (p = .018), and wound infection (p = .039) caused a significant increase in risk. CONCLUSION The incision, which is made during liver transplant, is important for the development of hernia. The J incision has a low hernia development rate without causing access problems. Regardless of the incision, high BMI index, male gender, postoperative bleeding, and wound infection increase the development of incisional hernia in liver transplant patients.
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Affiliation(s)
- Elbrus Zarbaliyev
- Department of General Surgery, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
| | - Murat Sevmiş
- Department of General Surgery and Transplantation, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
| | - Hakan Kilercik
- Department of Anesthesiology, Gaziosmanpaşa Hospital, Yeni Yüzyıl University, İstanbul, Turkey
| | - Sebahattin Çelik
- Department of General Surgery, Van Training and Research Hospital, Health Scıences Unıversıty, Van, Turkey
| | - Sema Aktaş
- Department of General Surgery and Transplantation, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
| | - Mehmet Çağlıkülekçi
- Department of General Surgery, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
| | - Şinasi Sevmiş
- Department of General Surgery and Transplantation, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
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Nielsen MF, de Beaux A, Stutchfield B, Kung J, Wigmore SJ, Tulloh B. Peritoneal flap hernioplasty for repair of incisional hernias after orthotopic liver transplantation. Hernia 2021; 26:481-487. [PMID: 33884521 PMCID: PMC9012720 DOI: 10.1007/s10029-021-02409-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/07/2021] [Indexed: 12/07/2022]
Abstract
Background Repair of incisional hernias following orthotopic liver transplantation (OLT) is a surgical challenge due to concurrent midline and transverse abdominal wall defects in the context of lifelong immunosuppression. The peritoneal flap hernioplasty addresses this problem by using flaps of the hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space, exploiting the retro-rectus space medially and the avascular plane between the internal and external oblique muscles laterally. We report our short and long-term results of 26 consecutive liver transplant cases with incisional hernias undergoing repair with the peritoneal flap technique. Methods Post-OLT patients undergoing elective peritoneal flap hernioplasty for incisional hernias from Jan 1, 2010–Nov 1, 2017 were identified from the Lothian Surgical Audit system (LSA), a prospectively-maintained computer database of all surgical procedures in the Edinburgh region of south-east Scotland. Patient demographics and clinical data were obtained from the hospital case-notes. Follow-up data were obtained in Feb 2020. Results A total of 517 liver transplantations were performed during the inclusion period. Twenty-six of these (18 males, 69%) developed an incisional hernia and underwent a peritoneal flap repair. Median mesh size (Optilene Elastic, 48 g/m2, BBraun) was 900 cm2 (range 225–1500 cm2). The median time to repair following OLT was 33 months (range 12–70 months). Median follow-up was 54 months (range 24–115 months) and median postoperative stay was 5 days (range 3–11 days). Altogether, three patients (12%) presented with postoperative complications: 1 with hematoma (4%) and two with chronic pain (8%). No episodes of infection or symptomatic seroma were recorded. No recurrence was recorded within the follow-up period. Conclusion Repair of incisional hernias in patients following liver transplantation with the Peritoneal Flap Hernioplasty is a safe procedure associated with few complications and a very low recurrence rate. We propose this technique for the reconstruction of incisional hernias following liver transplantation.
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Affiliation(s)
- M F Nielsen
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK.
- Department of Surgery, Hospital of Southern Denmark, Aabenraa, Danmark.
| | - A de Beaux
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK
| | - B Stutchfield
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK
| | - J Kung
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK
| | - S J Wigmore
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK
| | - B Tulloh
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK
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How-we-do-it: the repair of postoperative ventral hernias after a Mercedes abdominal incision. Langenbecks Arch Surg 2021; 406:2117-2123. [PMID: 33587182 DOI: 10.1007/s00423-021-02087-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/11/2021] [Indexed: 12/07/2022]
Abstract
PURPOSE To describe the abdominal wall reconstruction technique with an Ultrapro mesh and outcome for the repair of postoperative ventral hernias after the use of a Mercedes incision during the initial abdominal operation. METHOD A retrospective review of all the patients undergoing elective postoperative ventral hernia repair between 2013 and 2019. The cohort of these patients that had an initial Mercedes incision was used for this study. RESULTS Fourteen patients met the criteria for this study. Thirteen of the patients were transplant patients (10 liver transplant and 3 combined pancreas and kidney transplant), and one patient was after a hepatectomy. Fifty-seven percent of these hernias were multiple defects. All the patients underwent the same repair of a modified Rives-Stoppa, transversus abdominis release, and a bilateral transverse plication. A partially absorbable Ultrapro mesh was used for all the patients, with two of the patients needing an additional Symbotex mesh in order to bridge a portion of the posterior fascia. There were 6 minor early postoperative complications (hematoma, superficial wound infection, and seroma) that did not require reoperation. Two patients were readmitted for observation of a wound hematoma, and two patients (14.2%) had recurrence during the follow-up period. The average length of hospitalization was 5.6 days. CONCLUSION This technique, with the use of an Ultrapro mesh, was found to be safe and effective for the repair of a postoperative ventral hernia due to an initial Mercedes incision.
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Risk Factors for Surgical Site Occurrence or Infection and Recurrence After Incisional Hernia Repair in Abdominal Transplant Population. Transplant Proc 2021; 53:762-767. [PMID: 33551186 DOI: 10.1016/j.transproceed.2021.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/22/2020] [Accepted: 01/08/2021] [Indexed: 12/07/2022]
Abstract
PURPOSE To investigate risk factors for hernia recurrence, surgical site occurrence/infection (SSO/I) and those requiring procedural intervention (SSOPI) after incisional hernia repair (IHR) following abdominal transplantation. METHODS Patients undergoing IHR following abdominal transplant were retrospectively identified in the Americas Hernia Society Quality Collaborative database. Primary outcome measures were SSO/I, SSOPI and hernia recurrence. RESULTS There was a total of 166 patients. Seventeen patients (10%) had an SSO/I at 30 days. Overall complication rate was 26%, and there was 1 mortality (1%). Composite recurrence rate was 28% (21/75) over 2 years. In univariate analysis, history of diabetes (DM), body mass index (BMI) >35 kg/m2, and history of open abdomen were associated with SSO/I (P < .05). Immunosuppression had a negative correlation with SSO/Is and SSOPIs. BMI >35 kg/m2 was associated with 180-day recurrence, whereas history of hypertension remained significant for recurrence at 2 years (P < .05). CONCLUSION History of an open abdomen, DM, and obesity are risk factors for SSO/I, and obesity and hypertension are associated with short-term and long-term recurrence after IHR following abdominal organ transplantation. Immunosuppression had negative correlation with SSO/I. However, long-term outcomes and those related to immunosuppression should be interpreted cautiously in view of the small sample size and low follow-up rates. Baseline comorbidities seem to be the main drive for hernia outcomes for transplant population, similar to the general population. Larger cohorts and longer follow-up are necessary to delineate preventable risk factors for SSO/Is and hernia recurrences after organ transplantation.
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Garcia-Urena MA. Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? A critical review. Hernia 2021; 25:13-22. [PMID: 33394256 DOI: 10.1007/s10029-020-02348-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Incisional ventral hernias (IHs) are a common complication across all surgical specialities requiring access to the abdomen, pelvis, and retroperitoneum. This public health issue continues to be widely ignored, resulting in appreciable morbidity and expenses. In this critical review, the issue is explored by an interdisciplinary group. METHODS A group of European surgeons encompassing representatives from abdominal wall, vascular, urological, gynecological, colorectal and hepato-pancreatico-biliary surgery have reviewed the occurrence of His in these disciplines. RESULTS Incisional hernias are a major public health issue with appreciable morbidity and cost implications. General surgeons are commonly called upon to repair IHs following an initial operation by others. Measures that may collectively reduce the frequency of IH across specialities include better planning and preparation (e.g. a fit patient, no time pressure, an experienced operator). A minimally invasive technique should be employed where appropriate. Our main recommendations in midline incisions include using the 'small bites' suture technique with a ≥ 4:1 suture-to-wound length, and adding prophylactic mesh augmentation in patients more likely to suffer herniation. For off-midline incisions, more research of this problem is essential. CONCLUSION Meticulous closure of the incision is significant for every patient. Raising awareness of the His is necessary in all surgical disciplines that work withing the abdomen or retroperitoneum. Across all specialties, surgeons should aim for a < 10% IH rate.
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Affiliation(s)
- M A Garcia-Urena
- Hospital Universitario del Henares, Faculty of Health Sciences. Universidad Francisco de Vitoria, 28223, Pozuelo de Alarcón, Madrid, Spain.
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Yassein T, Elgady A, Ayoup I, Gaballa NK, Abbasy M, Abou‐Shady M, Osman M, Zakaria HM. Risk factors and management of incisional hernia in the recipients of living donor liver transplant: A single institutional experience. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Taha Yassein
- Department of Hepatopancreatobiliary and Liver Transplant Surgery National Liver Institute, Menoufia University Menoufia Egypt
| | - Ammar Elgady
- Department of Hepatopancreatobiliary and Liver Transplant Surgery National Liver Institute, Menoufia University Menoufia Egypt
| | - Islam Ayoup
- Department of Hepatopancreatobiliary and Liver Transplant Surgery National Liver Institute, Menoufia University Menoufia Egypt
| | - Nahla K. Gaballa
- Department of Anesthesia and Intensive Care National Liver Institute, Menoufia University Menoufia Egypt
| | - Mohamed Abbasy
- Department of Hepatology and Gastroenterology National Liver Institute, Menoufia University Menoufia Egypt
| | - Mohammed Abou‐Shady
- Department of Hepatopancreatobiliary and Liver Transplant Surgery National Liver Institute, Menoufia University Menoufia Egypt
| | - Maher Osman
- Department of Hepatopancreatobiliary and Liver Transplant Surgery National Liver Institute, Menoufia University Menoufia Egypt
| | - Hazem M. Zakaria
- Department of Hepatopancreatobiliary and Liver Transplant Surgery National Liver Institute, Menoufia University Menoufia Egypt
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Sobrado LF, Ernani L, Waisberg DR, Carneiro-D'Albuquerque LA, Andraus W. First case report of spigelian hernia containing the appendix after liver transplantation: Another cause for chronic abdominal pain. Int J Surg Case Rep 2020; 72:533-536. [PMID: 32698282 PMCID: PMC7322101 DOI: 10.1016/j.ijscr.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 12/07/2022] Open
Abstract
INTRODUCTION Abdominal ventral hernias are common in chronic liver disease due to increased abdominal pressure and sarcopenia. Following liver transplantation, diagnosis of chronic abdominal pain is challenging because it may relate to immunosuppression, scaring or opportunistic infections. PRESENTATION OF CASE A 62 years-old male presented with chronic abdominal pain one year following liver transplantation due to hepatocellular carcinoma. After work-up he was diagnosed with a Spigelian hernia containing the appendix. We did hernia repair with mesh but appendectomy was not performed since it showed no signs of inflammation. On follow-up the patient had complete resolution of the pain. DISCUSSION This is the first case of spigelian hernia containing the appendix following liver transplantation. Mesh repair can be safely performed in this setting but incidental appendectomy is controversial due to higher morbidity and mortality. In this case report we discuss the relationship between liver transplantation, abdominal hernias and the pitfalls of incidental appendectomy. CONCLUSION Uncommon ventral hernias are a possible cause for chronic abdominal pain after surgery and should be investigated with imaging studies. Mesh repair is safe but incidental appendectomy in the immunosuppressed is not encouraged due to increased morbidity.
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Affiliation(s)
- Lucas Faraco Sobrado
- Digestive Organs Transplant Unit, Department of Gastroenterology, Liver Transplantation Division, University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Lucas Ernani
- Digestive Organs Transplant Unit, Department of Gastroenterology, Liver Transplantation Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Daniel Reis Waisberg
- Digestive Organs Transplant Unit, Department of Gastroenterology, Liver Transplantation Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luiz Augusto Carneiro-D'Albuquerque
- Digestive Organs Transplant Unit, Department of Gastroenterology, Liver Transplantation Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Wellington Andraus
- Digestive Organs Transplant Unit, Department of Gastroenterology, Liver Transplantation Division, University of São Paulo School of Medicine, São Paulo, Brazil
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Gianchandani R, Pérez E, Moneva E, Menéndez A, Sánchez JM, Díaz C, Concepción V, Barrera MA. Laparoscopic Incisional Hernia Repair After Liver Transplantation: Long-Term Series and Literature Review. Transplant Proc 2020; 52:1514-1517. [PMID: 32265069 DOI: 10.1016/j.transproceed.2020.01.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
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Cos H, Ahmed O, Garcia-Aroz S, Vachharajani N, Shenoy S, Wellen JR, Doyle MM, Chapman WC, Khan AS. Incisional hernia after liver transplantation: Risk factors, management strategies and long-term outcomes of a cohort study. Int J Surg 2020; 78:149-153. [PMID: 32335240 DOI: 10.1016/j.ijsu.2020.04.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/09/2020] [Accepted: 04/19/2020] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Incisional hernias (IH) develop in up to 40% of liver transplant (LT) recipients and can contribute to considerable morbidity. MATERIALS AND METHODS A single center retrospective review of a prospectively maintained LT database was conducted to identify all patients diagnosed with IH after LT during a 13-year study period (2003-2015). Analyzed data included patient demographics, LT details, incidence and timing of IH, risk factors, management strategies and long-term outcomes. RESULTS During the 13-year study period, IH was diagnosed in 16.7% (163/976) of LT recipients after a median of 19.6 months (range 6.7-49.5 months) from transplant surgery. Identified risk factors for developing IH included male gender (p < 0.001) while acute cellular rejection (ACR) was found to be negatively associated with the risk of developing IH (p = 0.014). Acute incarceration/strangulation was seen in 4 patients with IH while the remaining (n = 159) presented with non-emergent symptoms. Surgical repair was undertaken in 70/163 (43%) IH patients after medical optimization when possible (open repair 83%, mesh use 90%). IH recurrence rate was 14.3% (10/70) with comparable rates in no-mesh and with-mesh repairs (42.9% vs. 11.3%; p = 0.057) and open (15.8%) and laparoscopic (9.1%) approaches (p = 0.68). CONCLUSION IH is a late complication following LT and male gender is a consistent predictive marker. Acute presentation is infrequent and elective repair can be planned in most patients allowing for risk factor optimization to ensure promising long-term outcomes.
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Affiliation(s)
- Heidy Cos
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Ola Ahmed
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA.
| | - Sandra Garcia-Aroz
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Neeta Vachharajani
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Surendra Shenoy
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Jason R Wellen
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Maria Mb Doyle
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - William C Chapman
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
| | - Adeel S Khan
- Division of Transplantation, Department of Surgery, Washington University in St Louis, USA
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