Incisional Hernia Repaired Using Thigh Muscle Fascia After Kidney Transplantation: A Case Report |
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| Affiliation: | 1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan;2. Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan;3. Division of Urology, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan;4. Department of Plastic and Reconstructive Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan;1. Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan;2. Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan;1. Department of Plastic and Reconstructive Surgery, School of Medicine, Kangwon National University Hospital, Chuncheon, Korea;2. Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea;1. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;2. International Institute for Bio-Resource Research, Meiji University, Kawasaki, Japan;3. Institute of Medical Science, University of Tokyo, Tokyo, Japan;1. Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan;2. Department of Nephrology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan;3. Department of General Internal Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan;4. Department of Gastroenterology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan;5. Department of Urology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan |
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| Abstract: | BackgroundAlthough monofilament mesh-based repair is a safe and effective procedure for incisional hernia (IH) in organ transplant patients, there is no definite evidence of IH treatment for patients with graft rejection and enhanced immunosuppressive therapy. We report a successful case of large IH repair using an autologous thigh muscle fascia sheet in a kidney transplant patient.Case PresentationA 69-year-old man had IH from the incision of kidney transplantation, which was performed 6 years ago. He had a large right lower abdominal distension hanging down to the inguinal portion. A computed tomography scan revealed a large IH with a maximum abdominal defect diameter of 15 cm. The hernia sac contained the intestine, colon, and transplanted kidney, which had pulled out along with the retroperitoneum and protruded into the abdominal wall. He had chronic active acute antibody-mediated rejection, which required frequent steroid pulse therapy and additional or adjusted immunosuppressive drugs. After total circumferential exposure of the hernia sac and abdominal fascia, the abdominal wall defect was closed using a horizontal mattress suture. The sutured line was covered with a thigh muscle fascia sheet harvested from the patient's right femur and attached to the closed fascia. He was discharged on postoperative day 13 without any complications, and no IH recurrence was observed 10 months after surgery.ConclusionsHernia repair using autologous tissue could be a treatment option for post-transplant IH with a higher risk of infection. |
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