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Vol. 98. Issue 6.
Pages 350-356 (June - July 2020)
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Vol. 98. Issue 6.
Pages 350-356 (June - July 2020)
Original article
DOI: 10.1016/j.cireng.2020.06.001
Incisional Hernia Repair Outcome After Renal Transplantation in a Reference Center. Our Experience of 7 Years
Resultados de la reparación de la hernia incisional asociada al trasplante renal en un centro especializado. Análisis de nuestra experiencia de 7 años
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Jesús Martínez-Hoeda,
Corresponding author
dr.martinezhoed@gmail.com

Corresponding author.
, Santiago Bonafe Dianaa, Antonio Torregrosa-Galluda, Providencia García Pastora, David Abelló Audia, Miriam Menéndez-Jiménez de Zavada y Lissóna, Fernando Carbonell Tatayb, José Bueno-Lledóa
a Unidad de Cirugía de Pared Abdominal y Corta Estancia, Hospital Politécnico y Universitario La Fe, Valencia, Spain
b Instituto Valenciano de Oncología, Valencia, Spain
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Tables (4)
Table 1. Demographic Data of Patients Treated Surgically for Incisional Hernia Secondary to Renal Transplantation Between January 1, 2011 and January 31, 2018.
Table 2. Distribution of the Patients With Incisional Hernia After Renal Transplantation in Our Series According to the EHS Incisional Hernia Classification.
Table 3. Classification of the Postoperative Complications of Patients Treated Surgically for Incisional Hernia Secondary to Renal Transplantation According to Clavien-Dindo.
Table 4. Series Published in the International Literature About Incisional Hernia Secondary to Renal Transplantation Between 1998 and 2018.
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Abstract
Introduction

Incisional hernias secondary to renal transplantation (IHRT) are considered complex hernias because they are lateral to the sheath of the rectus abdominis muscle. The presence of the graft in the iliac fossa and the proximity to the inguinal area, costal margin and iliac bones, as zones with difficult fixation for prostheses, increases repair complexity. In addition, these patients have specific characteristics, such as treatment with immunosuppressive medication, that could alter postoperative evolution. The objective of this study was to analyze the results obtained in IHRT repair at a tertiary hospital, and to compare these data with the international literature.

Methods

Retrospective observational study of patients treated surgically for IHRT in our unit from January 1, 2011 to January 31, 2018. Preoperative conditions, intraoperative factors and postoperative complications during follow-up were analyzed.

Results

Twenty-five patients underwent hernia repair, finding a 4% hernia recurrence rate during a median follow-up of 27.5 months (20–39). The most frequently used technique was the posterior transversus abdominis release component separation technique in 42%, followed by preperitoneal repair in 27% and interoblique repair in 12%. The overall postoperative morbidity was 23%, which was frequently related to the surgical site (12%).

Conclusions

IHRT repair is a safe procedure at our medical center, with an acceptable rate of hernia recurrence, but it is not without complications.

Keywords:
Kidney transplantation
Hernia
Hernioplasty
Incisional hernia
Resumen
Introducción

Las hernias incisionales secundarias al trasplante renal (HITR) se consideran hernias complejas debido a su localización lateral a la vaina del músculo recto abdominal. También influyen la presencia del injerto en la fosa iliaca y la proximidad del área inguinal, el margen costal y los huesos iliacos como rebordes de difícil fijación de la prótesis. Además, estos pacientes presentan connotaciones específicas, como el tratamiento con inmunosupresores, que podrían alterar la evolución postoperatoria. El objetivo del estudio fue analizar los resultados obtenidos en la reparación de las HITR en un hospital terciario, comparando estos datos con la literatura internacional.

Métodos

Estudio observacional retrospectivo, desde el 1 de enero de 2011 al 31 de enero de 2018, de los pacientes operados de HITR en nuestra unidad. Análisis de factores preoperatorios, intraoperatorios y de complicaciones postoperatorias observados durante el seguimiento.

Resultados

Se operaron 25 pacientes, encontrando un índice de recidiva herniaria del 4% tras un seguimiento mediano de 27,5 meses (20-39). La técnica más utilizada fue la separación posterior de componentes con liberación del transverso en un 42%, seguida de la reparación preperitoneal en un 27% y la reparación interoblicuos en un 12%. La morbilidad postoperatoria global fue del 23%, siendo las más frecuentes las relacionadas con el sitio quirúrgico (12%).

Conclusiones

La reparación de las HITR es un procedimiento seguro en nuestro centro, con un índice de recidiva herniaria aceptable, aunque no exento de complicaciones.

Palabras clave:
Trasplante renal
Hernia
Hernioplastia
Hernia incisional

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