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Invited Critique
March 16, 2009

Laparoscopic Incisional Hernia Repair After Solid-Organ Transplantation—Invited Critique

Arch Surg. 2009;144(3):233. doi:10.1001/archsurg.144.3.233

Laparoscopic repair of incisional hernias is increasingly becoming the procedure of choice over the open approach.1 Advantages of laparoscopic repair include lower rates of recurrence and complications as well as shorter hospital stay. Laparoscopic incisional hernia repair in solid-organ transplant recipients, however, is still unproved, and its safety and efficacy in these immunocompromised patients is unknown. This article describes the outcomes of LIHR in 31 transplant recipients, 21 of whom underwent liver transplantation. Only a minority of patients (23%) were receiving corticosteroid therapy. The superlative laparoscopic skills were evident in that operative times were relatively short, blood loss was minimal, and no conversion to open repair was required. Although the overall complication rate was 58%, the most frequent complication was the occurrence of seroma, which was managed expectantly. No bowel injuries occurred, and there was notably no occurrence of any mesh or wound infections. The results were even more commendable after taking into account that the hernias repaired were unconventionally large (mean [SD] mesh size, 611 [307] cm2). This may explain the relatively prolonged median (range) hospital stay (4 [1-28] days) in this series and the high overall recurrence rate (23%) within a relatively short follow-up (median, 589 days), including an even higher recurrence rate (42%) for initial repairs in liver transplant recipients. The results of this study indicate that laparoscopic repair of large incisional hernias and the use of mesh in solid-organ transplant recipients is safe in experienced hands. It is too early, however, to conclude that the laparoscopic approach is the preferred method of repairing incisional hernias in these patients, though it is probably just a matter of time before additional studies further demonstrate its efficacy and cost-efficiency.

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