An alternative abdominal closure technique after pediatric liver transplant: Bogota-bag technique
Emre Karakaya1, Aydıncan Akdur1, Hatice Ebru Ayvazoglu Soy1, Gökhan Moray1, Sedat Yildirim1, Mehmet Haberal1.
1General Surgery, Başkent University, ANKARA, Turkey
Introduction: In conditions such as large for size, postreperfusion hepatic edema, and intestinal edema, primary closure of the abdominal wall can cause respiratory complications, thrombosis of vascular structures due to compression of graft vascular structures, ischemia of the graft, and intestinal complications. In this study, we aimed to compare the results of primary abdominal closure (PAC) and temporary patch closure (bogoto-bag technique) (BB) in pediatric liver transplant recipients.
Material and Methods: The first liver transplant in 1988 was performed by our team. Between 8 December 1988 and 31 December 2021, we performed 701 liver transplant. Of these liver transplants 334 were pediatric and 367 were adults. We performed PAC in 295 recipients. In 39 pediatric liver transplant recipients, we preferred BB technique as the abdominal closure technique in patients with suspected intra-operative tense abdominal closure or intra-abdominal hypertension. In these patients we used this technique, we sutured the sterilized saline bag to the skin at the edge of the defect continuously with a 3/0 polypropylene suture by shaping the defect so as not to cause abdominal hypertension. PAC was achieved in patients after control laparotomies at 48-hour intervals.
Results: The mean age of the PAC group was 8.38 years, while the mean age of the BB group was 2 years. The average weight of the PAC group was 26.38 kg, and the average weight of the BB group was 7.93 kg. Biliary atresia was the most common indication in both groups. The mean length of hospital stay was 21 days in PAC group and 24 days in BB group. Six patients in the BB group were died due to sepsis or bleeding in the early postoperative period. Wound closure was achieved within 2 weeks in 25 patients and within 8 patients in three weeks.
Conclusion: Temporary patch closure technique can be used safely in experienced centers in low weight and young children, large for size and increased intra-abdominal pressure.
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