gms | German Medical Science

131. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

25.03. - 28.03.2014, Berlin

Integration of porcine dermal collagen after incisional hernia repair in immunosuppressed patients – a prospective controlled trial

Meeting Abstract

  • Georg Werkgartner - Universitätsklinik für Chirurgie, Klinische Abteilung für Allgemeinchirurgie, Graz
  • Thomas Rappl - Universitätsklinik für Chirurgie, Klinische Abteilung für Plastische Chirurgie, Graz
  • Daniela Kniepeiss - Universitätsklinik für Chirurgie, Klinische Abteilung für Transplantationschirurgie, Graz
  • Florian Iberer - Universitätsklinik für Chirurgie, Klinische Abteilung für Transplantationschirurgie, Graz
  • HansJörg Mischinger - Universitätsklinik für Chirurgie, Klinische Abteilung für Allgemeinchirurgie, Graz
  • Doris Wagner - Universitätsklinik für Chirurgie, Klinische Abteilung für Transplantationschirurgie, Graz

Deutsche Gesellschaft für Chirurgie. 131. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 25.-28.03.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14dgch013

doi: 10.3205/14dgch013, urn:nbn:de:0183-14dgch0134

Veröffentlicht: 21. März 2014

© 2014 Werkgartner et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Incisional hernias (IH) occur nearly universal after orthotopic liver transplantation (OLT). A permanent closure of these hernias is always complicated due to high infection and recurrence rates. Bovine dermal collagen (BDC) has been proposed as feasible closing aid but its use for immunosuppressed patients is crucial due to its immunogenity. The presented study aimed to investigate the feasibility of bovine dermal collagen as closing aid in hernias after OLT in a prospective controlled trial.

Patients and Methods: 55 patients (OLT group: 21 pts. after OLT, CTR group: 24 pts.) who suffered from IH with a diameter above 10 cm after transversal incisions were implanted a BDC graft for closure. Patients were followed prospectively for 24 months. Recurrence rates of IH served as primary, the development of infections and wound healing disorders as secondary end points. All IHs were repaired at the same center in the same standard using interrupted sutures placing the mesh in sublay technique. All patients received a single shot antibiotic prophylaxis using cefuroxim or clindamycin (existing allergies). In case of recurrence and subsequent reoperations biopsies of the BDC grafts were obtained and vessel ingrowth was measured in order to depict the grafts integration into the patients abdominal wall.

Results: Baseline parameters were comparable between both groups. The immunosuppressive regimen in the OLT group at the time of IH diagnosis and repair consisted of Mycophenolate Mofetil (all patients -1000 mg BID) in combination with Tacrolimus (13/21 pts - target trough levels 6-8 ng/mL) or Everolimus (8 pts – target trough levels 4–7 ng/mL), 3 patients received 5 mg aprednislone daily additionally. Recurrence rate according to abdominal ultrasound was 9% (2/21) in OLT patients and 5% (1/24) in the CTR group (p=0.054). Postoperative infections above the BDC mesh occured in 3 patients in the OLT and in 1 patient in the CTR group (p<0.05) during the first 5 days following mesh placement. All were managed with AB administration and one required surgical drainage. No wound healing disorders occured in any group. Histologic analysis of BDC mesh biopsies showed a comparable angiogenesis and integration of the BDC in immunosuppressed and in not immunosuppressed patients. Patients in the OLT group did not show significantly more postoperative infections (p=0.3). See Table 1 [Tab. 1].

Discussion: BDC is feasible in the closure of IH in patients with immunosuppression. Observed postoperative infection rates and recurrence rates of immunosuppressed patients only slightly exceed those of not immunosuppressed patients and are lower as compared to those stated in the literature for other IH closing methods.