Component separation of abdominal wall with intraoperative botulinum A presents satisfactory outcomes in large incisional hernias: a case report

Author(s):Show less -

Oliveira, Lucas Torres ^[1] ; Essu, Felipe Futema ^[1] ; Antunes de Mesquita, Gustavo Heluani ^[1] ; Jardim, Yuri Justi ^[1] ; Iuamoto, Leandro Ryuchi ^[1] ; Suguita, Fabio Yuji ^[1] ; Martines, Diego Ramos ^[1] ; Nii, Fernanda ^[1] ; Waisberg, Daniel Reis ^[2] ; Meyer, Alberto ^[2] ; Andraus, Wellington ^[2] ; Carneiro D'Albuquerque, Luiz Augusto ^[2]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Hosp Clin, Fac Med, Dept Gastroenterol, Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: INTERNATIONAL JOURNAL OF SURGERY CASE REPORTS; v. 41, p. 99-104, 2017.
• Web of Science Citations: 1

Abstract

PURPOSE: Transplantation patients have a series of associated risk factors that make appearance of incisional hernia (IH) more likely. A number of aspects of the closure of large defects remain controversial. In this manuscript, we present the repair of a large IH following liver transplantation through the technique of posterior components separation combined with the anterior, together with the intraoperative use of botulinum toxin A and the placement of mesh. As a secondary objective, we analyze the incidence of IH following liver transplantation in our service. METHODS: Between the years 2013 and 2016, 247 patients underwent liver transplantation in the Liver Transplantation Service at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brazil. We analyzed the incidence of IH in these patients. One of these cases operated in March 2017 presented a defect in the abdominal wall of 22 x 16.6 x 6.4 cm in the median and paramedian regions. We present the details of this innovative surgical technique. RESULTS: The total operating time was 470 min. During the postoperative phase the patient presented ileus paralysis, without systemic repercussions. Resumption of an oral diet on the fifth postoperative day, without incident. Hospital discharge occurred on the 12th postoperative day, with outpatient follow up. CONCLUSION: In our service, the incidence of incisional hernias following liver transplantation is 14.5%. We described a successful approach for selected patient group for whom there is no established standard treatment. Given the complexity of such cases, however, more studies are necessary. (C) 2017 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. (AU)

• FAPESP's process: 16/20446-1 - Effect of botulinum toxin a in the abdominal wall in transplant patients with incisional hernia: preoperative management
• Grantee: Lucas Torres Oliveira
• Support Opportunities: Scholarships in Brazil - Scientific Initiation