Temporary Abdominal Closure Technique After Pediatric Liver Transplant: Single-Center Experience

Area of Science:

• Hepatobiliary Surgery
• Pediatric Surgery
• Transplant Surgery

Background:

• Primary abdominal closure is standard after liver transplant but challenging in pediatric cases due to organ size discrepancies.
• Pediatric liver transplant recipients sometimes require larger-than-standard grafts, complicating abdominal closure.
• Temporary patch closure offers a solution for difficult abdominal wall closures in pediatric liver transplantation.

Purpose of the Study:

• To outline the experience with temporary patch closure of the abdominal wall after pediatric liver transplant.
• To evaluate the efficacy and outcomes of temporary abdominal closure techniques in young liver transplant recipients.

Main Methods:

• Retrospective analysis of 191 pediatric liver transplants (age < 10 years) performed between 1988 and the study period.
• Evaluation of cases requiring temporary abdominal closure, including graft type (whole liver vs. left lateral lobe) and closure method.
• Data collection on patient demographics, surgical indications for temporary closure, and materials used.

Main Results:

• Temporary closure was necessary in 31 (16.2%) of the 191 pediatric liver transplants analyzed.
• The Bogota bag patch was utilized in these cases, with 3 involving whole livers and 28 involving left lateral lobe grafts.
• Temporary abdominal closure was chosen for 22 patients due to intraoperative inability to close the abdomen.

Conclusions:

• Temporary patch closure is the treatment of choice for pediatric liver transplant patients facing difficult abdominal closure.
• Reinforced silicone sheeting is preferred for its minimal adhesion formation and transparent properties, allowing for donor liver monitoring.
• This technique effectively manages abdominal wall closure challenges in pediatric liver transplantation.