Safety of laparoscopic repair of incisional hernias in liver transplant recipients.

INTRODUCTION: Incisional hernia is a common complication following liver transplantation occurring in 5%-34% of patients. Traditionally, open repair was standard due to fear of abdominal adhesions, postoperative complications and lack of experience with laparoscopic techniques. Laparoscopic incisional hernia repair (LIHR) has now become routine in non-transplant patients, with improved postoperative outcomes. In this study, we compared outcomes after laparoscopic and open incisional hernia repair after liver transplantation at a high-volume liver transplant center. METHODS: We performed a retrospective cohort study including all incisional hernia repairs performed on post-liver transplant patients at a major liver transplant center in Australia from 2010 to 2021. Donor, recipient, intraoperative and postoperative variables were collected from the electronic medical record focusing on laparoscopic and open repairs. RESULTS: Between January 2010 and March 2021, 138 patients underwent incisional hernia repair: 40 laparoscopic (29%) and 98 open (71%). No difference in wound infection (2.5% vs. 7.7%, p = .243); wound dehiscence (.00% vs. 2.3%, p = .332) or hernia recurrence (16.3% vs. 23.0%, p = .352) was seen between treatment groups. For larger incisional hernias (>5 cm) we found that a laparoscopic repair reduced length of stay compared to open-repair (3.89 vs. 4.57 days, p = .026). CONCLUSION: Laparoscopic repair of larger incisional hernias reduced postoperative length of hospital stay, whilst potential advantages may include reduced wound complications and hernia recurrence. Importantly, laparoscopic repair did not increase postoperative complication rates and represents a safe technique for repair in this demographic.

Anatrophic nephrolithotomy and pyelolithotomy for dual staghorn calculi in bifid collecting system.

A bifid ureter is an atypical anatomical variation that occurs with an incidence of 1-10%. This anomaly is in a continuum of duplex collecting systems and most commonly involves a common distal ureter. This is usually asymptomatic and is predominantly an incidental diagnosis, nevertheless, is a potential risk factor for urolithiasis formation. Current surgical management of larger staghorn calculi favours percutaneous nephrolithotomy (PCNL) over traditional open surgery, however for multiple calculi and complex anatomy PCNL would require multiple punctures, with increased risk of bleeding, pleural injury, sepsis and ultimately failed stone clearance. We describe the case of a 71-year-old female with multiple calculi in bifid anatomy. A single open approach, aided with cold-ischaemia was successfully utilized in this context.

Procurement-related liver injury for transplantation: an analysis of the risk factors and consequences in an Australian transplant centre.

BACKGROUND: Liver transplantation is an established treatment for liver failure, and its success relies on the quality of the donated organ amongst other factors. Studies on procurement-related liver injury (PRLI) are few and some may not apply to modern-day practice. This is the first Australian study examining risk factors and consequences of PRLI. METHOD: The Victorian Liver Transplant Unit database was examined for deceased liver donors from 2010 to 2017. Information regarding the donor, retrieval and subsequent transplantation was obtained. PRLI details were sought from the 'organ retrieval report form'. PRLI risk factors and their complications were analysed. RESULTS: A total of 420 transplants were included, with 45 injuries in 44 livers (10%), and significant injuries were observed in 4%. Variant anatomy was associated with an increased risk of PRLI (11% vs. 2%, p < 0.001). Complication rates were not significantly different between livers with and without PRLI however a reduction in early graft survival was observed. CONCLUSION: This study shows that PRLI is common, and that variant anatomy is associated with an increased risk of injury. Appropriate feedback and benchmarking are important to maintain a high quality in donor surgery.