Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Thirty to fifty percent of complications in donor hepatectomy appear to be related to abdominal wall trauma, including hernia, bowel obstruction, and chronic abdominal discomfort. We sought to determine if placement of prophylactic absorbable mesh during living donor hepatectomy is associated with a reduction in the rate of post-operative incisional hernias.
*Methods: A retrospective chart review of all hybrid laparoscopic and open, or fully open, living donor hepatectomies by midline laparotomy was performed at Columbia University Medical Center and Weill Cornell College of Medicine/New York Presbyterian from January 2010 through September 2018. Incisional hernia rates and mesh-related complications were compared between patients with and without prophylactic mesh placement. In all cases in which mesh was placed, Phasix (BARD) fully absorbable mesh was sutured in an onlay fashion during closure. Patients were selected for mesh placement on the basis of BMI, age and abdominal wall depth.
*Results: Between 2010 and 2018, 122 patients underwent open or hybrid donor hepatectomy and of those, 26 patients received mesh. Among patients with a BMI of 27 or above, the rate of incisional hernia was reduced by 31% (OR .17, 95% CI .0334-.8607 P=.032). The rate of incisional hernia among all patients who underwent donor hepatectomy from 2010-2018 decreased from 19.7% to 7.7% with placement of prophylactic mesh, though this did not reach significance. Of those who received mesh, 4 out of 26 (15%) developed seromas post operatively and there were no wound infections or other mesh-related complications.
*Conclusions: Our data indicate that prophylactic mesh placement at the time of open or hybrid living donor hepatectomy is associated with a decrease in the rate of post-operative incisional hernias, especially in those at high risk for incisional hernia with a BMI of 27 or greater. Documented mesh-related complications were limited to seromas, a known phenomenon in this absorbable mesh metabolized by hydrolysis. This closure technique should be considered to minimize post-operative incisional hernia in an otherwise healthy donor population.
|With Mesh (n=26)||Without Mesh (n= 85)|
|Male||11 (42.3%)||42 (49.4%)|
|BMI 27 or greater||18 (69.2%)||33 (38.8%)|
|Hybrid technique||25 (96.2%)||73 (85.9%)|
|Incision length (cm)||17.5||16.9|
|Right hepatectomy||17 (65.4%)||50 (58.8%)|
|With Mesh (n=26)||Without Mesh (n = 85)|
|Incisional hernia||2 (7.7%)||14 (16.5%)|
|Incisional hernia (BMI 27 or greater)||2 (n=18, 11%)||14 (n=33, 42.4%)|
|Median time to hernia development (mos.)||6 (5-7)||9 (.75-36)|
|Average hernia defect size (cm)||14 (8-20)||12.6 (1-20)|
|Surgical site infection||0||5 (5.9%)|
|Overall followup (mos.)||12.7 (3-33)||25 (8-67)|
To cite this abstract in AMA style:Ahrens Dvon, Hwang R, Kato T, Emond J, Griesemer A, Samstein B. Absorbable Mesh Placement to Prevent Incisional Hernias after Donor Hepatectomy [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/absorbable-mesh-placement-to-prevent-incisional-hernias-after-donor-hepatectomy/. Accessed December 8, 2019.
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