SURGERY AND IMAGING - ADVANCES

R. Horneland¹, B.H. Lien¹, J. Lambrecht², O. Øyen^1
1Dep. For Transplant Surgery, Oslo University Hospital Rikshospitalet, Oslo/NORWAY, ²Surgical Dep., Innlandet Hospital Gjøvik, Gjøvik/NORWAY

Body: Introduction: Due to the immunosuppressive theraphy, incisional hernias are overrepresented in the transplanted population – and recurrences are common.
Minimally invasive procedures have in recent years gained widespread acceptance. Regarding incisonal hernia repair, the laparoscopic, minimally invasive procedure is now buy many considered ‘the gold standard’. The potential benefits of reducing incisions/tissue trauma would be suspected to be even greater in immunosuppressed patients. By avoiding the convential incision above the mesh, troublesome fluid accumulations, causing secretion and potentially infection, are greatly reduced.
Methods: As part of a multicentre study on laparoscopic incisional hernia repair, patients were randomised to +/÷ hernia raphi and mesh fixation (Parietex Composite Mesh) with either ‘transfascial sutures + single crown of tackers’ or ’double crown’ of tackers (4 groups; all laparoscopic) (Figure 1). The present series represent a sub-cohort of transplanted/immunosupprressed patients.
Results: Thirtytwo patients have been included. We hereby present the overall results (all randomisation groups pooled) of this transplanted cohort (Table 1), as no significant differences have been found between the various raphi/mesh fixation techniques. The technical-surgical differences between the groups were in reality minor, in part because raphi, in many cases, was not feasible/unattractive. Conclusions: Our rate of major postoperative complications., in an immunosuppressed series of patients, is low. And, a recurrence rate below 10% must be considered very satisfactory, as reports in the literature describe 15-50% recurrences - though a reservation has to made due to the short observational time.
Nevertheless, we feel confident to conclude that the minimally invasive procedure seems particularly rationale in immunosuppressed patients, with significantly retarded wound healing, and should be the method of choice in this population. [Video-presentation]

Disclosure: All authors have declared no conflicts of interest.