Closing the abdomen: update on the current surgical toolkit

Area of Science:

• Surgical Reconstruction
• Transplantation Surgery
• Abdominal Wall Surgery

Background:

• Abdominal wall closure after intestinal transplantation (ITx) presents significant surgical challenges.
• Closure failure occurs in 25-50% of ITx cases, linked to reduced abdominal domain, fistulae, and adhesions.
• Inability to achieve closure is an independent risk factor for mortality and graft loss.

Purpose of the Study:

• To review and summarize current surgical options for achieving abdominal wall closure after intestinal transplantation.
• To highlight the importance of successful abdominal closure in ITx outcomes.
• To discuss the range of techniques available for complex abdominal wall defects.

Main Methods:

• Review of current literature on abdominal wall closure techniques post-intestinal transplantation.
• Summarization of reconstructive options, including mesh reinforcement and fascial grafts.
• Discussion of advanced imaging and immunological considerations.

Main Results:

• Tension-free repair is essential for successful abdominal closure.
• Techniques range from primary fascial closure with mesh reinforcement to complex reconstructive procedures.
• Options include synthetic/biological mesh, non-vascularised/vascularised rectus fascia, and full-thickness abdominal wall transplantation.

Conclusions:

• A variety of techniques exist to facilitate abdominal wall closure after ITx.
• Advances in imaging, reconstructive surgery, and immunology expand the available surgical toolkit.
• A tailored approach, identifying patients with potential closure issues preoperatively and selecting the simplest effective technique, is crucial.