Optimal surgical management in kidney and pancreas transplantation to minimise wound complications: A systematic review and meta-analysis

BACKGROUND: Immunosuppression in transplant patients increases the risk of wound complications. However, an optimal surgical approach to kidney and pancreas transplantation can minimise this risk. MATERIALS AND METHODS: We performed a systematic review and meta-analysis to examine factors contributing to incisional hernia formation in kidney and pancreas transplant recipients. Bias appraisal of studies was conducted via the Newcastle-Ottawa scale. We considered recipient factors, surgical methods, and complications of repair. RESULTS: The rate of incisional hernia formation in recipients of kidney and pancreas transplants was 4.4% (CI 95% 2.6–7.3, p < 0.001). Age above or below 50 years did not predict hernia formation (Q (1) = 0.09, p = 0.77). Body mass index (BMI) above 25 (10.8%, CI 95% 3.2–30.9, p < 0.001) increased the risk of an incisional hernia. Mycophenolate mofetil (MMF) use significantly reduced the risk of incisional hernia from 11.9% (CI 95% 4.3–28.7, p < 0.001) to 3.8% (CI 95% 2.5–5.7, p < 0.001), Q (1) = 4.25, p = 0.04. Sirolimus significantly increased the rate of incisional hernia formation from 3.7% (CI 95% 1.7–7.1, p < 0.001) to 18.1% (CI 95% 11.7–27, p < 0.001), Q (1) = 13.97, p < 0.001. While paramedian (4.1% CI 95% 1.7–9.4, p < 0.001) and Rutherford-Morrison incisions (5.6% CI 95% 2.5–11.7, p < 0.001) were associated with a lower rate of hernia compared to hockey-stick incisions (8.5% CI 95% 3.1–21.2, p < 0.001) these differences were not statistically significant (Q (1) = 1.38, p = 0.71). Single layered closure (8.1% CI 95% 4.9–12.8, p < 0.001) compared to fascial closure (6.1% CI 95% 3.4–10.6, p < 0.001) did not determine the rate of hernia formation [Q (1) = 0.55, p = 0.46]. CONCLUSIONS: Weight reduction and careful immunosuppression selection can reduce the risk of a hernia. Rutherford-Morrison incisions along with single-layered closure represent a safe and effective technique reducing operating time and costs.