The Utility of Open Component Separation with Biologic Mesh in the Transplant Population with Complex Abdominal Hernias

Background

Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression. Repair of these hernias is further complicated by multiple previous laparotomies. In addition, hernias from transplants occur in non-midline incisions such as large Mercedes, subcostal incisions or the pelvic “Gibson” incision used for kidney transplants. We conducted a retrospective review of transplant patients who underwent recurrent hernia repair to analyze outcomes and hernia recurrence.

Methods

This is a single center, retrospective, review of patients presenting to MedStar Georgetown University hospital from 2010-2017. All patients had received either kidney or liver transplantation prior to presenting with an incisional hernia. All hernias were repaired with open component separation (CST) with biologic mesh underlay technique.

Results

The mean age of patients was 60 yrs old (±8.3), with a mean BMI of 28 (±5.9), 13 males (81%), and 3 females (19%). There were 9 liver transplant patients and 6 kidney transplant patients. Hypertension was the most common comorbidity (12 patients, 75%), followed by diabetes (8 patients, 50%), and hyperlipidemia (6 patients, 38%). Mean prior surgeries were 1.6 per patient, including 5 patients with prior incisional hernia repairs. All patients underwent open CST with biologic mesh underlay and  primary fascial approximation. Complications were experienced by 4 patients (25%) including 1 hematoma, 1 seroma, and 2 hernia recurrences (12.5%) at long term follow up. There were no infections. All patients ultimately healed at a mean time of 28 days.

Conclusion.

This small, retrospective series of complex open CST in patients after liver or kidney transplantation shows an acceptable long term hernia recurrence rate and overall healing rate.  By using a multidisciplinary approach and plastic surgery techniques for abdominal wall reconstruction, we believe that open CST with biologic mesh is a safe and effective technique in the transplant population with abdominal hernias.