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Procurement for a Vascularized and Reinnervated Abdominal Wall Allotransplantation
Published on: July 18, 2025
Definitive abdominal wall closure using a porcine intestinal submucosa biodegradable membrane in pediatric
Jonathan S Karpelowsky1, Gordon Thomas, Albert Shun
1Department of Pediatric Surgery, Children's Hospital at Westmead, Sydney, NSW, Australia. jonathan.karpelowsky@uct.ac.za
Insights
Surgisis, a biodegradable membrane, offers a safe and durable solution for abdominal wall closure in pediatric transplant patients under 10 kg. This method effectively prevents complications like abdominal compartment syndrome and incisional hernias.
Area of Science:
- Pediatric surgery
- Transplantation surgery
- Biomaterials science
Background:
- Abdominal closure in pediatric transplant recipients (<10 kg) is challenging.
- Tight closure risks abdominal compartment syndrome and graft loss.
- Prosthetic patches raise concerns of infection and dehiscence.
Purpose of the Study:
- To evaluate the safety and efficacy of porcine intestinal submucosa (Surgisis) for abdominal wall closure in pediatric liver and kidney transplant patients.
- To assess outcomes including complications, graft survival, and long-term durability.
Main Methods:
- Prospective study of 12 pediatric transplant patients (<10 kg) requiring abdominal wall augmentation with Surgisis.
- Included 10 liver and 2 kidney transplant recipients.
- Follow-up averaged 15.3 months.
Main Results:
- Surgisis facilitated closure in 11 of 12 patients, with delayed closure averaging 3.75 days.
- No incisional hernias were observed.
- Two wound complications (sinuses, skin dehiscence) occurred but healed without graft removal; no graft loss due to infection.
Conclusions:
- Surgisis is a safe and effective biomaterial for abdominal closure in pediatric transplant patients.
- It demonstrates long-term durability and resistance to infection, preventing incisional hernias.
- This method addresses challenges in managing small pediatric transplant recipients.
Abstract:
Abdominal closure in children less than 10 kg following liver or kidney transplantation can be challenging. Excessive pressure attained from a tight closure can result in abdominal compartment syndrome, graft compromise and loss. Concerns over using prosthetic patches are that of infection and dehiscence. We report a series of definitive abdominal wall closure using a biodegradable membrane from porcine intestinal submucosa (Surgisis; Cook Biotech Incorporated, West Lafayette, IN, USA). A prospective collection and follow up of liver and kidney transplant patients weighing less than 10 kg who required abdominal wall augmentation with Surgisis in order to achieve satisfactory closure. There were 10 liver and two renal transplant patients. The average weight of the liver transplant patients was 6.6 kg (5.4-8.5 kg) and the renal 9.8 kg. The average area of Surgisis used was 71.2 cm(2) (25-160 cm(2)) and length of follow up was 15.3 months (1-27 months). Concomitant measures to aid abdominal closure included bilateral recipient nephrectomy for the renal patients and reduction by 33% of the lateral segmental grafts in two liver transplant patients. Delayed closure occurred in all patients except one and the average days to closure from the first surgery was 3.75 days (0-6 days). Following liver transplantation one patient died from multiple organ failure at one month secondary to hemophagocytosis from underlying combined immune deficiency syndrome and one patient with hepatic artery thrombosis was salvaged at re-exploration. There were two wound complications, one patient developed two small sinuses and some skin dehiscence which healed over four months and the second developed a skin sinus following trans-patch liver biopsy which healed in three wk. Both had positive microbial cultures but neither necessitated removal of the graft. There were no incisional hernias. Surgisis is a safe method for facilitating abdominal closure in pediatric transplant patients. It appears to have long-term durability with no incisional hernias on short- and medium-term follow up, and is fairly resistant to infection.
