sirolimus and Hernia--Ventral

Incisional hernias are a frequent complication of upper abdominal wall interventions, especially in patients undergoing liver transplantation with subsequent immunosuppressive therapy. Therefore, we analyzed in this study the manner in which the incorporation of a surgical mesh for hernia repair is affected by the immunosuppressant drugs rapamycin and cyclosporine A (CsA). For this purpose, Ultrapro meshes were implanted into the dorsal skinfold chambers of rapamycin- and CsA-treated hamsters. Untreated animals served as controls. The angiogenic and inflammatory host tissue response to the mesh implants was then analyzed over a 14-day period by means of intravital fluorescence microscopy. Mesh incorporation was determined by histology and measurement of explantation strength. Rapamycin dose-dependently inhibited vascularization of implanted meshes, as indicated by a significantly reduced number of angiogenesis-positive regions of interest and microvessel density, when compared with CsA-treated hamsters and controls. In addition, the granulation tissue surrounding the meshes of rapamycin-treated animals exhibited only a low collagen content, resulting in an impaired mesh incorporation with a significantly reduced explantation strength. Leukocyte-endothelial cell interaction did not show marked differences between the observation groups. Thus, immunosuppressed patients should not be treated with rapamycin in case of incisional hernia repair in order to guarantee adequate mesh incorporation.

Topics: Animals; Cell Adhesion; Cricetinae; Cyclosporine; Endothelial Cells; Hernia, Abdominal; Hernia, Ventral; Immunosuppressive Agents; Leukocytes; Male; Mesocricetus; Microvessels; Neovascularization, Physiologic; Sirolimus; Surgical Mesh

Incisional hernias occur in up to 17% of patients after liver transplantation. Laparoscopic ventral hernia repair is associated with fewer wound complications and a decreased incidence of recurrence when compared to open hernia repair in nontransplant patients. This is a retrospective review of 13 patients who underwent laparoscopic incisional hernia repair (LAP group) after liver transplantation compared to 14 patients who had open repairs (OP group; all but one with mesh). Primary immunosuppression in both groups at the time of transplantation was tacrolimus, but more patients in the LAP group were on sirolimus at the time of hernia, while more patients in the OP group were on prednisone at the time of hernia repair. All operations were completed with a laparoscopic approach; there were no conversions to open. Length of stay differed significantly between the 2 groups, with a mean of 5.4 days for the LAP group compared to 2.7 days in the OP group (0.0059). Complications occurred in 2 (15%) of the patients in the LAP group and 5 (36%) in the OP group. One patient in the LAP group required mesh removal to exclude causes of recurrent ascites, and 1 in the OP group for mesh infection. One (7.6%) of the patients in the LAP group developed a recurrence, compared to 29% (4) of the OP group (P =0.3259). In conclusion, laparoscopic incisional hernia repair is safe in patients after liver transplantation, with a low risk of infection or recurrence.

Topics: Aged; Female; Graft Rejection; Hernia, Ventral; Humans; Immunosuppressive Agents; Laparoscopy; Liver Transplantation; Male; Middle Aged; Mycophenolic Acid; Postoperative Complications; Prednisone; Recurrence; Retrospective Studies; Sirolimus; Surgical Mesh; Surgical Wound Infection; Tacrolimus