Laparoscopic repair of boundary incisional hernia in a kidney transplanted patient. A safe tacks-fibrin glue combined mesh fixation technique

Introduction Incisional hernia in renal transplant patients is a complication that affects negatively the global outcome of transplant and the quality of life. The repair of this condition was classically made by open repair with mesh. Increasing evidences suggest that laparoscopic repair could be advocated as the technique of choice in these patients with optimal results. However the fixation of mesh should be performed by a mixed combination of fibrin sealant (lateral margin of wall defect) and tacks (medial margin). The tacks fixation of the mesh along the lateral margin of the wall defect, close to the graft, is generally difficult for the small size of the remaining aponeurotic plane, and dangerous for the underlying presence of the graft. Materials and Methods a case of incisional hernia in a kidney transplant recipient was repaired by laparoscopic mesh technique. The polypropylene-polyglycolic acid (PGA) composite mesh was fastened with a mixed technique of absorbable tacks for medial margin of the defect and fibrin sealant for the lateral side in contiguity with graft surface. Results The patient was discharged after 4 days. The 6 months follow-up did not show mesh displacement or recurrence of hernia. Conclusions The laparoscopic mesh repair may become the gold standard for kidney transplant patients affected by incisional hernia. The difficulties of mesh fixation close to the graft can be overcome by the combination of fibrin sealant glue and absorbable tacks at different margins of the wall defect. This technique may offer advantages for this population of patients.