Invited Critique |

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

Michael E. de Vera, MD
Arch Surg. 2009;144(3):233. doi:10.1001/archsurg.144.3.233.
Text Size: A A A
Published online


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.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles