Wound complications in liver transplantation: effect of incision type and suture material.

BACKGROUND

The superiority of incision type in liver transplant has yet to be clearly established.

METHODS

In this study, we reviewed all liver-only transplant recipients at the Simmons Transplant Institute from 2012 to 2018 and divided them based on two incision types: Mercedes (M) and hockey stick (HS).

RESULTS

A total of 765 patients met inclusion criteria: 278 had an M incision (36%) and 487 had an HS incision (64%). There was no difference between groups based on sex, age, body mass index, presence of ascites pretransplant, and prior open abdominal surgeries. After transplant, the incidence of fascial dehiscence and subsequent incisional hernia repairs between groups was the same. However, patients with an M incision had more wound infections (4.3% vs 1.2%, P = 0.007), required more wound vacuum-assisted closure device placements (25% vs 13%, P < 0.001), and had higher rates of washouts (25% vs 14%, P < 0.001). There was no difference in wound complications between the use of polydioxanone or polypropylene (Prolene) as the fascial closing suture of choice. Significant risk factors for the development of an incisional hernia included sex, age, and body mass index.

CONCLUSION

Our results indicate that M incisions require greater postoperative wound care.