USE OF INTRAPERITONEAL PTFE DUAL-MESH IN A GIANT INCISIONAL HERNIA AFTER RENAL TRANSPLANTATION: A CASE REPORT

Abstract

Objectives: We evaluated the incidence of incisional hernia after kidney transplantation, predisposing factors and the results of surgical repair of a giant incisional hernia by intraperitoneal PTFE dual mesh. Patients and methods: We report our experience about an incisional hernia in a 55 years male after renal transplantation treated with an intraperitoneal dual mesh prosthesis. The cause of incisional hernia was probably due to an urinoma for a total necrosis of distal graft ureter that needed to reopen in 2sd day post transplant with primary fascial approximation. Thirty days after transplantation we discovered a large incisional hernia that rapidly became monstrous with migration of omentum and small bowel in the sac. The giant hernia was repaired with a tension free technique by intraperitoneal positioning of a PTFE dual-mesh prosthesis, laterally anchored to inguinal ligament with 2-0 interrupted polipropilene stitches. Medially the prosthesis was anchored to peritoneal plane by interrupted transparietal stitches with an overlap of 5 cm. After a 2-0 polipropilene 180°double running suture was performed around the hernial border with an overlap of 2 cm. No drain was used. The patients continued his immunosuppressive therapy (CyA, MMF, prednisolone). Results: The patients was discharged in 4th day after operation with no complications. After six months ultrasonographic follow up, the prosthesis was still positioned between the inguinal ligament and posterior abdominal wall Conclusions: Incisional hernia is not rare after renal transplantation but the incidence is unknow. Immunosuppression based on corticosteroids and a higher prevalence of co-morbidity, such as obesity, diabetes, chronic pulmonary disease and others, probably are the causes of a major incidence of incisional hernia in these patients. Surgical complications of renal transplantation surgery, such as wound hematoma, urinoma, lymphocele are the most important predisposing factors for incisional hernia. Finally in our country, transplanted patients have higher risk of incisional hernia due to a long period of dialysis while awaiting transplantation. In these patients the use of intraperitoneal PTFE dual-mesh is feasible, safe, and easy.