Abstract
The employment of synthetic mesh for incisional hernia repair in kidney-transplanted patients is rarely reported in the present literature. Many authors believe that mesh employment in such conditions is not safe due to fear of mesh related complications. From 1965 through 1999, a total of 1685 kidney transplants were performed at our Kidney Transplant Unit and 19 patients developed eventrations in the kidney transplant incision, an incidence of 1.1%. From September 1996 eight of these patients had prosthetic repair of the abdominal wall with onlay polypropylene mesh. All patients were under immunosuppressive therapy with prednisone, ciclosporine and azathioprine. Mean age was 48.8 years, mean body mass index was 22.5 and mean number of previous abdominal operations was 2.5. A large polypropylene mesh (Marlex® mesh) was fixed over the aponeurosis after primary closure of the aponeurotic borders, as an onlay graft. There was neither morbidity nor mortality associated to the surgical procedure. No recurrences or long-term complications associated with mesh employment were verified after a follow-up ranging from one year to three years. We concluded that prosthetic repair of incisional hernia in transplanted patients can be performed routinely.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Amid PK, Schulman AG, Lichtenstein IL, Hakakha M (1994a) Biomaterials for abdominal wall hernia surgery and principles of their applications. Langenbecks Arch Chir 379: 168–171
Amid PK, Schulman AG, Lichtenstein IL (1994b) A simple stapling technique for prosthetic repair of massive incisional hernias. Am Surg 60: 934–937
Amid PK, Lichtenstein IL (1996) Retromuscular Alloplastik groBerNarbenruche: eine einfache Heftklammertechnik. Chirurg 67: 648–652
Amid PK (1997) Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1: 15–21
Bendavid R (1992) The rational use of mesh in hernias. A perspective. Int Surg 77: 229–231
Boyd WC (1977) Use of Marlex mesh in acute loss of the abdominal wall due to infection. Surg Gynecol Obstet 144: 251–252
Bucknall TE, Cox PJ, Ellis H (1982) Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J 284: 931–933
Carlson MA, Ludwig KA, Condon RE (1995) Ventral hernia and other complications of 1,000 midline incisions. South Med J 88: 450–453
Cervelli V, Giudiceandrea F, Grimaldi M, Maggiulli G, Pagliarini T, Iaria G, Bruzzighes M, Cervelli G, Casciani CU (1997) Plastica della parete addominale per laparocele in paziente con pregresso trapianto renale. Minerva Chir 52: 817–821
Chevrel JP, Neidhardt JPH, Flament JB, Rives J (1998) Defects of the abdominal wall. In: JP Chevrel (ed) Hernias and surgery of the abdominal wall. Springer-Verlag, Berlin, Heidelberg, New York pp 111–169
Clemente Ramos LM, Burgos Revilla FJ, Gomez Dosantos V, Orofino Ascunce L, Pascual Santos J, Perez de Oteyza J, Escudero Barrilero A (1998) Reconstructive Surgery with polypropylene mesh associated with kidney transplant. Actas Urol Esp 22: 320–325
Colombo PL, Roveda S, Belisomo M, BianchI C, Pulvirenti A, Tinozzi S (1992) Large abdominal incisional hernias. Our experience with prosthetic repair. Minerva Chir 47: 161–170
Deguzman LJ, Nyhus LM, Yared G, Schlesinger PK (1995) Colocutaneous fistula formation following polypropylene mesh placement for repair of a ventral hernia: diagnosis by colonoscopy. Endoscopy 27: 459–461
Dibello JN Jr, Moore JH Jr (1996) Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias. Plast Reconstr Surg 98: 464–469
Ellis H, Gajraj H, George CD (1983) Incisional hernias: when do they occur? Br J Surg 70: 290–291
George CD, Ellis H (1986) The results of incisional hernia repair: a twelve year review. Ann R Coll Surg Engl 68: 185–187
Gislason H, Gronbech JE, Soreide O (1995) Burst abdomen and incisional hernia after major gastrointestinal operations. Comparison of three closure techniques. Eur J Surg 161: 349–354
Hesselink VJ, Luijendijk RW, De Wilt JHW, Heide R, Jeekel J (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176: 228–234
Houck JP, Rypins EB, Sarfeh IJ, Juler GL, Shimoda KJ (1989) Repair of incisional hernia. Surg Gynecol Obstet 169: 397–399
Israelsson LA, Jonsson T (1997) Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg 163: 175–180
Kaufman Z, Engelberg M, Zager M (1981) Fecal fistula, a late complication of Marlex mesh repair. Dis Colon Rectum 24: 543–544
Kennedy GM, Matyas JA (1994) Use of expanded polytetrafluoroethylene in the repair of the difficult hernia. Am J Surg 168: 304–306
Lamont PM, Ellis H (1988) Incisional hernia in reopened abdominal incisions: an overlooked risk factor. Br J Surg 75: 374–376
Langer S, Christiansen J (1985) Long term results after incisional hernia repair. Acta Chir Scand 151: 217–219
Lazaro da Silva A (1979) Surgical correction of longitudinal median or paramedian incisional hernia. Surg Gynecol Obstet 148: 579–583
Leber GE, Garb JL, Alexander AI, Reed WP (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133: 378–382
Liakakos T, Karanikas I, Panagiotidis H, Dendrinos S (1994) Use of Marlex mesh in the repair of recurrent incisional hernia. Br J Surg 81: 248–249
Mathes SJ, Stone HH (1975) Acute traumatic losses of abdominal wall substance. J Trauma 15: 386–391
McLanahan D, King LT, Weems C, Novotney M, Gibson K (1997) Retrorectus prosthetic mesh repair of midline abdominal hernia. AmJ Surg 173: 445–449
Medina M, Sillero M, Martinez Gallego G, Delgado Rodriguez M (1997) Risk factors of surgical wound infection in patients undergoing herniorrhaphy. Eur J Surg 163: 191–198
Moore SW, Conn J, Guida PM (1968) Recurrent abdominal incisional hernias. Surg Gynecol Obstet 126: 1015–1022
Morris-Stiff GJ, Hughes LE (1998) The outcomes of nonabsorbable mesh placed within the abdominal cavity: literature review and clinical experience. J Am Coll Surg 186: 352–367
Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72: 70–71
Otchy DP, Wolff BG, Van Heerden JA, Ilstrup DM, Weaver AL, Winter LD (1995) Does the avoidance of nasogastric decompression following elective abdominal colorectal surgery affect the incidence of incisional hernia? Results of a prospective, randomized trial. Dis Colon Rectum 38: 604–608
Paul A, Korenkov M, Peters S, Fischer S, Holthausen U, Kohler L, Eypasch E (1997) Mayo duplication for treatment of incisional hernias following conventional laparotomy. Results of a retrospective analysis. Zentralbl Chir 122: 862–870
Priestley GC, Brown JC (1980) Effect of corticosteroids on the proliferation of normal and abnormal human connective tissue cels. Br J Dermatol 102: 35–41
Santora TA, Roslyn JJ (1993) Incisional hernia. Surg Clin North Am 73: 557–570
Seelig MH, Kasperk R, Tietze L, Schumpelick V (1995) Enterocutaneous fistula after Marlex net implantation. A rare complication after incisional hernia repair. Chirurg 66: 739–741
Stone HH, Fabian TC, Turkleson ML, Jurkiewicz MJ (1981) Management of acute full-thickness losses of the abdominal wall. Ann Surg, 193: 612–618
Stoppa R, Louis D, Verhaeghe P, Henry X, Plachot JP (1987) Current surgical treatment of post-operative eventrations. Int Surg 72: 42–44
Sugerman HJ, Kellum JM Jr, Reines HD, Demaria EJ, Newsome HH, Lowry JW (1996) Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171: 80–84
Temudom T, Siadati M, Sarr MG (1996) Repair of complex giant or recurrent ventral hernias by using tension-free intraparietal prosthetic mesh [Stoppa technique]: lessons learned from our inicial experience [fifty patients]. Surgery 120: 738–744
Thomas III WO, Parry SW, Rodning CB (1993) Ventral/incisional abdominal herniorrhaphy by fascial partition/release. Plast Reconstr Surg 91: 1080–1086
Trupka AW, Schweiberer L, Hallfeldt K, Waldner H (1997) Management of large abdominal wall hernias with foreign implant materials [Goretex patch]. Zentralbl Chir 122: 879–884
Usher FC (1961) A new technique for repairing large abdominal wall defects. Arch Surg 82: 108–115
Usher FC, Allen JE, Crosthwait RW, Cogan JE (1962) Polypropylene monofilament. A new, biologically inert suture for closing contaminated wounds. JAMA 179: 780
Vestweber KH, Lepique F, Haaf F, Horatz M, Rink A (1997) Results of recurrent abdominal wall hernia repair using polypropylene mesh. Zentralbl Chir 122: 885–888
Voyles CR, Richardson JD, Bland KI, Tobin GR, Flint LM, Polk HC Jr (1981) Emergency abdominal wall reconstruction with polypropylene mesh: short-term benefits versus long-term complications. Ann Surg 194: 219–223
Waldrep DJ, Shabot MM, Hiatt JR (1993) Mature fibrous cyst formation after Marlex mesh ventral herniorrhaphy: a newly described pathologic entity. Am Surg 59: 716–718
White RA (1988) The effect of porosity and biomaterial on the healing and long-term mechanical properties of vascular prostheses. ASAIO J 11: 95–100
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Birolini, C., Mazzucchi, E., Utiyama, E.M. et al. Prosthetic repair of incisional hernia in kidney transplant patients. A technique with onlay polypropylene mesh. Hernia 5, 31–35 (2001). https://doi.org/10.1007/BF01576162
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01576162