Introduction: Primary abdominal wall closure after pediatric left lateral segment (LLS) liver transplantation for small children may not be possible or advisable, with delayed wall closure, monosegmental use or liver graft hyperreduction being possible alternatives. We describe our results with sequential abdominal closure (SAC) in pediatric LLS. recipients.
Methods: Retrospective review of patients who received LLS and SAC with polytetra-fluoroethylene mesh (2010-2021). Polytetra-fluoroethylene mesh was placed and fixed with continuous polypropylene suture to the wall on both sides of the incision. Mesh flap approaches were performed in the intensive care unit under sedation, with ultrasound control before and after, without requiring intubation. The mesh was removed in the operating room under general anesthesia after complete approximation of the flaps. Data were recorded from patient records after ethics committee approval.
Results: Of 198 who received an LLS, 86 (43.4%) required a SAC. Mean age was 2±3.1 years and mean weight 9.2±5.4 Kg. LLS was obtained from living donors (54.6%) and split (45.4%) with a mean graft weight of 324.1g. The graft weight/recipient weight ratio was 3.9±1.4%. The mesh was removed after 8.2±3.4 days, requiring 3.2±1.6 sequential approaches. We recorded 6 surgical wound infections, 5 dehiscences. No systemic infection related to the mesh or compartment syndrome occurred. It was directly removed in 81.4%, while 18.6% were reoperated for complications prior to mesh removal. After definitive closure, 1 (1.2%) patient had partial dehiscence and 6 (7%) suffered surgical wound infections. No grafts were lost due to sac procedure-related causes. The median follow-up time was 53 (15-84.3) months.
Conclusions: SAC offers a useful, reproducible and safe alternative for difficult abdominal closure after pediatric liver transplantation of LLS. The presence of the mesh during the immediate postoperative period represents an advantage for the review of graft status and possible complications in the immediate postoperative period.