Long term outcomes of abdominal wall reconstruction using open component separation and biologic mesh in the liver, kidney, and small bowel transplant population

• Published in: Hernia : the journal of hernias and abdominal wall surgery 2020-06, Vol.24 (3), p.469-479
• Main Authors: Zolper, E. G., Black, C. K., Devulapalli, C., Wang, J., Mahan, M., Kroemer, A. H., Hawksworth, J. S., Matsumoto, C. S., Girlanda, R., Fishbein, T. M., Sher, S. R., Evans, K. K.
• Format: Article
• Language: English
• Subjects: Abdominal Muscles - surgery; Abdominal Surgery; Abdominal wall; Abdominal Wall - surgery; Adult; Aged; Bioprosthesis - adverse effects; Demography; Diabetes mellitus; Female; Forum on Complexities in Hernia; Hernia; Hernia, Ventral - etiology; Hernia, Ventral - surgery; Herniorrhaphy - adverse effects; Herniorrhaphy - methods; Humans; Immunosuppressive agents; Intestine, Small - transplantation; Kidney transplantation; Kidney Transplantation - adverse effects; Liver transplantation; Liver Transplantation - adverse effects; Male; Medicine; Medicine & Public Health; Middle Aged; Organ Transplantation - adverse effects; Original Article; Patients; Population; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Recurrence; Reoperation - adverse effects; Retrospective Studies; Small intestine transplantation; Statistical analysis; Steroid hormones; Surgery; Surgical mesh; Surgical Mesh - adverse effects; Time Factors; Tobacco; Treatment Outcome
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-019-02117-1

Purpose The aim of this study is to critically examine the multidisciplinary approach to abdominal wall reconstruction (AWR) in the solid organ transplant (SOT) population at our institution, MedStar Georgetown University Hospital, using a modified component separation technique (CST). Methods A retrospective review of AWR utilizing modified open CST with biologic mesh in SOT patients was performed from January 2010 to June 2018. Patient demographics, comorbidities, operative details, complications, and outcomes were recorded. Descriptive statistics, logistic and linear regression analyses were performed to appraise outcomes. Results Thirty-five patients were included; mean age was 53 years. Patient demographics and comorbidities were: 82.9% male, 45.7% history of tobacco use, and 28.6% diabetes. Fifty-one percent had undergone prior hernia repair. Transplant types were: kidney (9), liver (16), liver/kidney (1), small bowel (7), multivisceral (2). All were on an immunosuppressive regimen at time of surgery; 22.9% included steroids. Average defect size was 361 cm 2 . Additional soft tissue procedures were performed in 65.7% ( n  = 23) of patients. Median time to healing was 29.0 days. Complication rate was 31.4% ( n  = 11); six patients required reoperation within 90 days. Recurrence rate was 5.7% ( n  = 2) at mean of follow up of 3.0 years. Additional soft tissue procedures were statistically significant for healing time ( p  = 0.037). Steroid use was statistically significant for reoperation within 90 days (OR = 12.500; 95% CI 1.694–92.250); however, steroid use was not significant after correction for confounders. Conclusion Modified open CST with biologic mesh is a safe, efficacious approach to complex AWR in the SOT population with recurrence rates comparable to the general population.