Abstract
Purpose
Organ transplantation is widely accepted as the treatment of choice for native organ failure. Due to required immunosuppression, however, organ recipients are prone to wound infections, incisional hernias, and fascial dehiscence. These complications are especially dangerous in this patient population, as they can compromise the survival of the transplanted organ. Various methods have been employed to repair ventral and incisional hernias in these patients. These include primary repair, synthetic mesh, biologic mesh, tensor fascia lata grafts (TFL), component separation, flaps from the thighs, or a combination of these. The goal of this study was to review the experience at our institution with ventral hernia repair in transplant patients and to compare outcomes of the various repair techniques.
Methods
Patients with liver, renal, or pancreas transplants requiring immunosuppression who underwent a ventral or incisional hernia repair at the University of Maryland from 2000–2005 were reviewed retrospectively. Factors examined include type and location of hernia, type of repair, post operative infection, hernia recurrence, reoperation, mesh removal, and length of follow up. Complication rates were compared using odds ratio and chi-square.
Results
A total of 104 patients met the criteria with a mean length of follow up of 26 months. Of these, 34 patients had repair with human acellular dermal matrix (HADM), 26 had synthetic mesh, 25 had primary repair, and 9 had TFL. Rates of wound infection in these groups were 15, 65, 8, and 11% respectively (χ 2 = 28, P < 0.001). Rates of recurrence were 24, 77, 36, and 11% respectively (χ 2 = 22, P < 0.001). The rate of mesh removal with HADM and synthetic mesh were 12 and 69%, respectively (χ 2 = 14, P < 0.001). When comparing HADM and synthetic mesh, the odds ratio for wound infection is 11 (95% CI 3.2–38) and for mesh removal is 8.7 (95% CI 2.6–28).
Conclusion
When repairing ventral or incisional hernias in immunosuppressed transplant patients, HADM provides significantly reduced morbidity from reduced rates of infection, recurrence, and need for operative removal of mesh.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Scientific Registry of Transplant Recipients, http://www.ustransplant.org/
Humar A, Ramcharan T, Denny R, Gillingham KJ, Payne WD, Matas AJ (2001) Are wound complications after a kidney transplant more common with modern immunosuppression? Transplantation. 72:1920–1923
Vardanian AJ, Farmer DG, Ghobrial RM, Busuttil RW, Hiatt JR (2006) Incisional hernia after liver transplantation. J Am Coll Surg 203:421–425
Kahn J, Muller H, Iberer F, Kniepeiss D, Duller D, Rehak P, Tscheliessnigg K (2007) Incisional hernia following liver transplantation: incidence and predisposing factors. Clin Transplant 21:423–426
Mathes SJ, Steinwald PM, Fpster RD, Hoffman WY, Anthony JP (2000) Complex abdominal wall reconstruction: a comparison of flap and mesh closure. Ann Surg 232:586–596
Williams JK, Carlson GW, deChalain T, Howell R, Coleman JJ (1998) Role of tensor fasciae latae in abdominal wall reconstruction. Plast Reconstr Surg 101:713–718
Gruen RL, Morrison WA, Vellar ID (1998) The tensor fasciae latae myocutaneous flap closure of major chest and abdominal wall defects. Plast Reconstr Surg 68:666–669
Sukkar SM, Dumanian GA, Szczerba SM, Tellez MG (2001) Challenging abdominal wall defects. Am J Surg 181:115–121
Li EN, Silverman RP, Goldberg NH (2005) Incisional hernia repair in renal transplantation patients. Hernia 9:231–237
Pless TK, Pless JE (1993) Giant ventral hernias and their repair. A 10 year follow up study. Scand J Plast Reconstr Surg Hand Surg 27:311–315
Luijendijk RW, Hop WC, ven den Tol MP et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398
Silverman RP, Li EN, Holton LH 3rd, Sawan KT, Goldberg NH (2004) Ventral hernia repair using allogenic acellular dermal matrix in a swine model. Hernia 8(4):336–342
Patton JH Jr, Berry S, Kralovich KA (2007) Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions. Am J Surg 193:360–363
Espinosa-de-los-Monteros A, de la Torre JI, Marrero I, Andrades P, Davis MR, Vasconez LO (2007) Utilization of human cadaveric acellular dermis for abdominal hernia reconstruction. Ann Plast Surg 58:264–267
Nemeth NL, Butler CE (2009) Complex torso reconstruction with human acellular dermal matrix: long-term clinical follow-up. Plast Reconstr Surg 123:192–196
Jin J, Rosen MJ, Blatnik J et al (2007) Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? J Am Coll Surg 205:654–660
Ventral Hernia Working Group (VHWG) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558
Menon NG, Rodriguez ED, Byrnes CK, Girotto JA, Goldberg NH, Silverman RP (2003) Revascularization of human acellular dermis in full-thickness abdominal wall reconstruction in the rabbit model. Ann Plast Surg 50(5):523–527
Kim H, Bruen K, Vargo D (2006) Acellular dermal matrix in the management of high risk abdominal wall defects. Am J Surg 192:705–709
Diaz JJ Jr, Guy J, Berkes MB, Guillamondegui O, Miller RS (2006) Acellular dermal allograft for ventral hernia repair in the compromised surgical field. Am Surg 72:1181–1187
Butler CE, Langstein HN, Kronowitz SJ (2005) Pelvic, abdominal, and chest wall reconstruction with AlloDerm in patients at increased risk for mesh-related complications. Plast Reconstr Surg 116:1263–1274
Acknowledgment
This study was funded in part by a grant from LifeCell Corporation, Branchburg, NJ.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Brewer, M.B., Rada, E.M., Milburn, M.L. et al. Human acellular dermal matrix for ventral hernia repair reduces morbidity in transplant patients. Hernia 15, 141–145 (2011). https://doi.org/10.1007/s10029-010-0748-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-010-0748-y