2011 - ISBTS 2011 Symposium


This page contains exclusive content for the member of the following sections: TTS, ITA. Log in to view.

Plenary Session IV: Tissue Engineering and Oral Communications 14

19.304 - Closure of the abdominal wall with Alloderm mesh in intestinal transplantation

Presenter: Richard S., Mangus, Indianapolis, United States
Authors: Richard S. Mangus1, Chekar Kubal1, A Joseph Tector1, Jonathan Fridell1, Karl Klingler1, Rodrigo Vianna1

304
Closure of the abdominal wall with Alloderm mesh in intestinal transplantation

Richard S. Mangus, Chekar Kubal, A Joseph Tector, Jonathan Fridell, Karl Klingler, Rodrigo Vianna

Surgery, Indiana University School of Medicine, Indianapolis, IN, United States

Introduction: Loss of abdominal domain is a frequent problem in intestinal transplantation. Inadequate abdominal space can be addressed at the time of transplant with graft reduction, choice of a smaller donor, fascia closure with mesh or tissue, or simultaneous transplantation of the donor abdominal wall. Mesh reconstruction of the abdominal wall may consist of either permanent or non-permanent material, from a variety of biologic and synthetic sources. This study reports the outcomes for a large number of intestinal transplant patients who have undergone abdominal wall closure with Alloderm biologic mesh.

Methods: This single center study reviews the records of 146 intestinal transplant patients between 2004 and 2010. The abdominal wall closure for all patients was reviewed and categorized as primary fascial closure or closure with any foreign material. Mesh closures were with either Alloderm or other mesh material. A thorough chart review was performed to assess complications specifically related to fascia reconstruction including reoperation for perioperative dehiscence, hernia or enterocutaneous fistula.

Results: There were 37 of 146 patients (25%) who required implantation of a foreign material for fascial closure at the time of transplant (109/146 primary repair (75%)). Of these 37, 30 (81%) had implantation of an Alloderm mesh and 7 (19%) received implantation of another mesh. Perioperative dehiscence was rare with 2/109 (2%) in the primary closure group, 0/30 (0%) in the Alloderm group and 1/7 (14%) in the other mesh group. Ventral hernias were only repaired if they were symptomatic. There were 12/146 (8%) of patients that underwent ventral hernia repair. The incidence of hernia by repair type was: primary closure 7/109 (6%), Alloderm mesh 3/30 (10%), and other mesh 2/7 (28%). There were 15/146 (10%) of patients who required surgery for fistula, 4 enterocutaneous and 11 gastrocutaneous (gastrostomy tube site). For the 4 enterocutaneous fistulas, closures included: 2/109 (2%) primary closure, 1/30 (3%) alloderm, and 1/7 (14%) synthetic mesh.

Conclusions: Abdominal wall reconstruction with Alloderm biologic mesh provides an expeditious means of performing a tension-free closure of the fascial layer after intestinal transplantation.  Complications associated with use of this material are similar to those seen with primary closure of the fascia, but much lower than those seen with other types of mesh. In our experience, successful use of Alloderm mesh requires aggressive interventions to achieve and maintain skin coverage over the mesh, and to avoid use of suction devices (drains / wound vac) directly over the mesh.


Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Social

Contact

Staff Directory
+1-514-874-1717
info@tts.org

Address

The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada