Surgical Approach to Abdominal Wall Defects and Hernias in Patients with End Stage Organ Disease and Transplantation

Abdominal wall hernias are one of the most common pathologies seen in the surgical world. Over one million abdominal hernia repairs take place in the USA every year. Abdominal wall defects represent a difficult challenge in patients with End Stage Organ Disease (ESOD) particularly those who suffer from chronic liver disease. Ascites, malnutrition, and increased abdominal pressure are some of the factors that predispose them to a greater risk for developing abdominal wall defects, in a population that in most cases are not ideal candidates for surgery. Recipients of abdominal organs, specifically after liver transplantation, are known to have a much higher risk of developing incisional hernias. In many series the incidence can be greater than 20%. Factors prompting to the development of a wall defect vary from patient to patient; the location and complexity of the defect, administration of immunosuppression, post-transplant complications, and the specific anatomy of the different incisions play a key role in the classification and risk stratification.