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Incisional Hernia – Liver Transplant post-surgical guidance

What is an incisional hernia?

An incisional hernia is a type of hernia that occurs at the site of an incision from a previous abdominal surgery. It happens when the area of the surgical wound fails to heal properly, resulting in a weakness in the abdominal wall. This weakness allows internal tissues or organs to protrude through the incision site, creating a bulge.​

Here are some key points about incisional hernias:​ Symptoms may include a visible bulge at the incision site, pain, and discomfort, especially when straining or lifting objects. In some cases, there might be redness, swelling, or signs of infection.​

When does it happen?

An incisional hernia can occur anytime postoperatively and has been reported in some studies as late as 4 years post-surgery.​

How often does it happen?

Incidents of incisional hernias have a wide variation reported in studies. Between 4-46% of liver transplant surgeries can result in an incisional hernia.

Can I do anything to prevent an incisional hernia?

  • Personal risk factors: Address what personal risk factors you may have such as smoking cessation, diabetes management or your weight before your surgery through your prehabilitation programme.
  • Education on Movement: It is important to avoid activities that put pressure on the wound area. This includes getting in and out of bed slowly, by rolling onto your side first, and then pushing up using your arms. (see post-transplant booklet)
  • It is important to avoid overexerting yourself by lifting heavy objects that cause pain. However, movement is essential for helping your recovery including regular short walks, deep breathing exercises, and doing stairs. ​
  • If a movement or activity causes pain around your wound, stop, rest and seek guidance from your healthcare team. ​
  • If you have a persistent cough or chest infection make sure you are taught to manage your cough, support your wound and clear your chest sputum/mucous with minimal pain/strain by a physiotherapist before you leave the hospital.​
  • Make sure you maintain a good nutritious diet to promote wound healing.​
  • The best advice will always be personalised to your lifestyle and post-surgical recovery journey so always consult with your medical team for personalised advice.​

References:

  1. Ayvazoglu Soy EH, Kirnap M, Yildirim S, Moray G, Haberal M. Incisional Hernia After Liver Transplant. Exp Clin Transplant. 2017 Feb;15(Suppl 1):185-189. doi: 10.6002/ect.mesot2016.P65. PMID: 28260464.​
  2. Mireia Dominguez Bastante, Maria Carmen Montes Osuna, Alfonso Mansilla Rosello, Jesus Villar del Moral, Liver Transplant and Incisional Hernia: What Do We Know and What Can We Improve, Transplantation Proceedings, Volume 55, Issue 10, 2023, Pages 2278-2281, https://doi.org/10.1016/j.transproceed.2023.09.003.​
  3. Ferri JVV, Dick SM, Grezzana-Filho TJM, Feier FH, Prediger L, Lazzaretti GS, Kruel CRP, Corso CO, Cavazzola LT, Chedid MF. EARLY INCISIONAL HERNIA AFTER LIVER TRANSPLANTATION: RISK FACTORS AND HERNIA REPAIR RESULTS. Arq Bras Cir Dig. 2022 Nov 4;35:e1698. doi: 10.1590/0102-672020220002e1698. PMID: 36350959; PMCID: PMC9645553.​
  4. Heidy Cos, Ola Ahmed, Sandra Garcia-Aroz, Neeta Vachharajani, Surendra Shenoy, Jason R. Wellen, Maria MB. Doyle, William C. Chapman, Adeel S. Khan, Incisional hernia after liver transplantation: Risk factors, management strategies and long-term outcomes of a cohort study, International Journal of Surgery, Volume 78, 2020, Pages 149-153, https://doi.org/10.1016/j.ijsu.2020.04.048.​
  5. Smith L, Meggy A, Watts T, Knight L, Torkington J, Cornish J. Incisional hernia prevention: risk-benefit from a patient perspective (INVITE) – protocol for a single-centre, mixed-methods, cross-sectional study aiming to determine if using prophylactic mesh in incisional hernia prevention is acceptable to patients. BMJ Open. 2022 Dec 30;12(12):e069568. doi: 10.1136/bmjopen-2022-069568. PMID: 36585153; PMCID: PMC9809247.​