1. 1: Cardiff Transplant Unit, University Hospital of Wales, Cardiff
Outcomes of laparoscopic incisional hernia repair in kidney/pancreas transplant patients.
Elijah Ablorsu 1,2
1: Cardiff Transplant Unit, University Hospital of Wales, Cardiff
2: Department of General Surgery, University Hospital of Wales, Cardiff
Results
Background
Transplant recipients are known to have a significantly higher risk of surgical complications after incisional hernia repair. These patients suffer from chronic medical problems and in addition they are immunocompromised to prevent organ rejection. These factors are known to strongly participate on developing post-operative complications (infection, impair healing, hernia recurrence, etc.).
There is enough evidence to suggest that laparoscopic incisional hernia repair (LIHR) is associated with fewer complications, reduced recurrence and postoperative pain, and also shorter hospital stay compared to open repair (OIHR). Four years ago we introduced laparoscopic hernia repair in transplant patients. In this study we analyzed outcomes of this technique in comparison to open repair.
Outcomes
Demographics
LIHR
OIHR
Patient number 6
Sex (F:M)
2:4
Age (years) 59 50
BMI
28.9
30.9
Pancreas vs. kidney transplant
1:5
3:2
Time after transplant (months) 66 44
Steroid tretment
50%
33% DM 0%
16.7%
Hypertension
67%
83%
COPD
Hernia location
-lower midline vs. groin
50%:50%
Hernia defect diameter
5.8 cm
5.7 cm
LIHR
OIHR
Seroma 2
P<0.05
Infection 1
Antibiotic treatment
Bowel injury
1-year recurrence
LOHS (days) 4 8
P=0.125
Methods
Between Jan 2011 and May 2013, we performed incisional hernia repair in 12 transplant patients (5 LIHR and 7 OIHR). Three patients in OIHR group previously received a combined pancreas-kidney transplant. All patients in the study had functioning graft at the time of surgery. Aim of this study was to compare incidence of early postoperative complications, hospital stay and 1-year recurrence.
Surgergical technique:
OIHR – Polypropelen mesh repair with sub-lay technique
LIHR – IPOM techniques with tissue separating mesh (Physiomesh™) and defect closure if possible with Nylon suture.
Kidney graft
Summary
We showed that LIHR is associated with reduced incidence of post-operative complications and shorter hospital stay. Therefore we suggest this is effective technique with superior outcomes compare to open repair in transplant patient with incisional hernia.
This patient group might even more benefit from this minimal invasive approach compare to non-immunocompromised patients.