2017 - CIRTA

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3- Donor Selection and Technical Aspects of Intestine Transplantation

27.9 - Use of Abdominal Wall, non-vascularized, non-composite allografts after abdominal organ transplantation, update on long term follow up of a single center series

Presenter: Gabriel, Gondolesi, Buenos Aires, Argentina
Authors: Pablo Farinelli, Juan Rubio, Nicolás Aguirre, Carolina Rumbo, Héctor Solar, Diego Ramisch, Gabriel Gondolesi

Use of Abdominal Wall, non-vascularized, non-composite allografts after abdominal organ transplantation, update on long term follow up of a single center series

Pablo A. Farinelli1, Juan S. Rubio1, Nicolás Aguirre1, Carolina Rumbo1, Héctor Solar1, Diego A. Ramisch1, Gabriel E. Gondolesi1.

1Intestinal Failure, Rehabilitation and Transplant Unit – HPB Surgery and Liver Transplant Unit, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina

Introduction: The abdominal wall (AW), may be severely compromised in the vast majority of intestinal and multiorgan transplant candidates, and sometimes as consequence of a complex liver transplant. Multiple options have been described to overcome this problem. Our aim is to report the largest and longest-term follow-up of patients that received an AW, non-Vascularized, non-Composite allograft (AW-non-V non-CA), as it has been proposed to call the Abdominal Rectus Fascia; after liver, intestinal or multiorgan transplantation at a single center.

Methods: This is a retrospective report of a prospectively collected data set of all the patients (pts.) that received AW-non-V non-CA after a liver, isolated intestine, combined, or multiorgan transplantation at our institution, from May 2006 to June 2016.

Results: A total of 19 pts. received an AW-non-V non-CA  from 2006 to 2016; 17 after an intestinal containing graft: and 2 after liver re-transplantation. Nine pts. were children. Mean follow-up 52.17 ± 43.6 months. No pts. develop ventral hernias. Three patients required replacement of the AW-non-V non-CA; 2 by a synthetic mesh and 1 with other ARF. Twelve recipients of the AW-non-V non-CA (63.15%) required 23 re-operations (re-op). Six pts required early re-op, 5 pts required late re-op and 1 pt. both. Late re-op were performed by transecting the ARF, throughout the midline. In all late re-op, the ARF was found to be integrated to the AW; and none or mild soft adhesions to the inner surface of the AW-non-V non-CA were found. None of the 2 patients who received liver re-transplantation and ARF developed ventral defects, or required re-op. Conclusion: The use of ARF, a AW-non-V non-CA, has become a simple and reliable surgical option to close abdominal wall defects after abdominal organ transplantation; it is capable of resisting multiple re-op, wound infections and, when necessary, it could be replaced. In the long term it does integrates to the abdominal wall and does not cause adhesions when the inner peritoneal layer is preserved.

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