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Presenter: Diego, Ramisch, Bs As, Argentina
Authors: Diego Ramisch1, Juan Manuel Padín1, Pablo Farinelli 1, Dolores Garcia Herva1, Guillermo Pfaffen1, Carolina Rumbo1, Gabriel Gondolesi1
Diego Ramisch, Juan Manuel Padín, Pablo Farinelli , Dolores Garcia Herva, Guillermo Pfaffen, Carolina Rumbo, Gabriel Gondolesi
Instituto de Trasplante Multiorganico Unidad de Rehabilitación, Nutrición y Transplante Intestinal, Hospital Universitario - Fundación Favaloro, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
Introduction: Abdominal wall closure remains an important challenge in the intestinal transplant (Tx) field. Different surgical strategies have been described to increase abdominal domain: use of prosthetic mesh, acellular dermis matrix, vascularized abdominal wall graft, or abdominal rectus fascia (ARF). We aim to present our experience in the immediate and long term surgical management of patients receiving ARF at the time of intestinal transplantation.
Materials and Methods: This is a retrospective report of patients that received ARF during isolated, combined, or multivisceral (MTV) Tx in a single centre from May 2006 to April 2011.
Results: 7/29 (24%) recipients needed the use of ARF at the time of abdominal wall closure, 4 isolated, 1 combined, 2 MTV Tx. The need for ARF was established before the Tx procedure and it was requested at the time of the procurement. ARF was prepared as previously published by this group. In all cases skin flaps were movilized to close above the ARF. Five/7 patients (pts) needed 10 re-operations (RO); 9 RO were done during the first month. The ARF was removed and re-implanted in 5 RO (4 due to intra-abdominal collections and 1 for bleeding). The other 4 early RO (1 for abdominal collections and 3 for bleeding), were performed in 2 pts; the ARF was re-implanted during the first procedure in the both cases, but a new ARF from a second donor was used for the final closure in one pt. The 10thRO was performed 26.4 months post-Tx due to small bowel obstruction. The re-laparotomy was performed opening the midline. Intra-operative findings were positive for adhesions in the pelvis with no adhesions in the inner ARF surface. Abdominal wall was closed with running polypropilene sutures. Six/7 pts are alive at a mean follow up of 24 months (range: 3 days to 52 months), 1pt died 4 months post-Tx with GVHD.
Conclusions: The use of ARF is a simple and reliable surgical option to close abdominal wall defects during intestinal Tx. The tissue resisted multiple RO, wound infections and when necessary it could be replaced with other compatible ARF. In the long term it doesn’t cause adhesions when the inner peritoneal layer was preserved.
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