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Goetz, Markus ; Jurczyk, Maria ; Grothues, Dirk ; Knoppke, Birgit ; Junger, Henrik ; Melter, Michael ; Schlitt, Hans J. ; Brunner, Stefan M. ; Brennfleck, Frank W.

Biological abdominal wall expansion in pediatric liver recipients after transplantation with large‐for‐size organs

Goetz, Markus , Jurczyk, Maria, Grothues, Dirk , Knoppke, Birgit, Junger, Henrik, Melter, Michael , Schlitt, Hans J. , Brunner, Stefan M. und Brennfleck, Frank W. (2022) Biological abdominal wall expansion in pediatric liver recipients after transplantation with large‐for‐size organs. Pediatric Transplantation 27 (1), e14405.

Veröffentlichungsdatum dieses Volltextes: 10 Jan 2023 08:09
Artikel
DOI zum Zitieren dieses Dokuments: 10.5283/epub.53501


Zusammenfassung

Background After pediatric split liver transplantation, intra-abdominal loss of domain due to large-for-size left lateral grafts is a frequent problem for fascial closure and potentially leads to reduced liver perfusion and abdominal compartment syndrome. Therefore, delayed fascial closure with the use of temporary silastic meshes and reoperation or alternative fascial bridging procedures are ...

Background After pediatric split liver transplantation, intra-abdominal loss of domain due to large-for-size left lateral grafts is a frequent problem for fascial closure and potentially leads to reduced liver perfusion and abdominal compartment syndrome. Therefore, delayed fascial closure with the use of temporary silastic meshes and reoperation or alternative fascial bridging procedures are necessary. Methods Between March 2019 and October 2021, biologic meshes were used for abdominal wall expansion in 6 cases of pediatric split liver transplantation. These cases were analyzed retrospectively. Results One male and 5 female children with median age of 6 months (range: 0-57 months) and weight of 6 kg (range: 3.5-22 kg) received a large-for-size left lateral graft. Graft-to-recipient weight ratio (GRWR) was 4.8% (range: 1.5%-8.5%) in median. Biologic mesh implantation for abdominal wall expansion was done in median 7 days (range: 3-11 days) after transplantation when signs of abdominal compartment syndrome with portal vein thrombosis in 3 and of the liver artery in 1 case occurred. In 2 cases, bovine acellular collagen matrix and 4 cases ovine reinforced tissue matrix was used. Median follow-up was 12.5 months (range: 4-28 months) and showed good liver perfusion by sonography and normal corporal development without signs of ventral hernia. One patient died because of fulminant graft rejection and emergency re-transplantation 11 months after the initial transplantation. Conclusions Biologic meshes can be used as safe method for abdominal wall expansion to achieve fascial closure in large-for-size liver transplant recipients. Usage for primary fascial closure can be considered in selected patients.



Beteiligte Einrichtungen


Details

DokumentenartArtikel
Titel eines Journals oder einer ZeitschriftPediatric Transplantation
Verlag:WILEY
Ort der Veröffentlichung:HOBOKEN
Band:27
Nummer des Zeitschriftenheftes oder des Kapitels:1
Seitenbereich:e14405
Datum6 Oktober 2022
InstitutionenMedizin > Lehrstuhl für Chirurgie
Medizin > Lehrstuhl für Kinder- und Jugendmedizin
Identifikationsnummer
WertTyp
10.1111/petr.14405DOI
Stichwörter / KeywordsRECTUS FASCIA; HERNIA REPAIR; CLOSURE; MESH; MATRIX; SAFE; abdominal compartment syndrome; complications of liver transplantation; large-for-size grafts; pediatric liver transplantation; surgical complications
Dewey-Dezimal-Klassifikation600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin
StatusVeröffentlicht
BegutachtetJa, diese Version wurde begutachtet
An der Universität Regensburg entstandenJa
URN der UB Regensburgurn:nbn:de:bvb:355-epub-535013
Dokumenten-ID53501

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