{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:31:59Z","timestamp":1790163119881,"version":"4.1.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":3134,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2007,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Primary fascial closure is often difficult after adult orthotopic liver transplantation (OLT), complicated by donor-to-recipient graft size mismatch, post-reperfusion hepatic edema, coagulopathy, or intestinal edema. Attempts at closing the abdomen under these circumstances can cause increase in intra-abdominal pressures, resulting in significant complications, including graft loss. Temporary closure with silastic mesh has been used as a viable option in children receiving transplants, but there is no experience recorded with its use in adults. A retrospective review was conducted on 200 consecutive liver transplantations performed over 42 months (October 2002 to February 2006). Records were evaluated for patient and donor demographics, perioperative factors including Model for End-Stage Liver Disease and Child-Turcotte-Pugh scores, indications for OLT, ischemic times, blood product administration, and use of temporary silastic mesh closure. Patients requiring silastic mesh were further evaluated for indication, time to primary fascial closure, duration of intubation, length of stay, graft function, and complications (infectious, vascular, biliary, and hernia development). Comparisons were made with a cohort of patients undergoing OLT over the same time period but who were closed primarily, without the use of temporary silastic mesh. Fifty-one liver transplantations (25.5%) of the 200 total transplant cohort used silastic mesh closure. Comparison of the cohorts (primary closure vs. temporary mesh) revealed that no differences existed, except the requirement of all blood products was significantly greater in the silastic mesh group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Bowel edema (47.1%) and coagulopathy (37.3%) were the most common indications for mesh closure, with less frequent reasons including donor to recipient size mismatch (11.8%), hemodynamic instability, and a large preexisting fascial defect (2.0% each). The average time from transplant to final fascial closure was 3.4 days (range 2\u20139 days). In the silastic cohort, 41 transplants where closed primarily, 3 required the addition of synthetic mesh, and 6 had component separation and flap closure. After fascial closure, the mean time to extubation was 1 day. The median length of follow-up was 1.3 years for the silastic closure group. Long-term wound complications in the silastic closure group included 1 instance of colonic fistula, 2 incisional hernias, and 2 wound infections. The 30-day and 1-year patient survival for this group were 93.6 and 82.4%, respectively, and the graft survival for those same periods were 90.2 and 77.7%, respectively. Wound complications, rates of hepatic artery thrombosis or stricture, portal vein thrombosis or stricture, biliary complications, and allograft and patient survival were no different than those in patients undergoing initial primary closure. In adult liver transplantation with a difficult (or potentially difficult) abdomen, temporary closure with silastic mesh was found to allow for uncomplicated fascial closure in a short period of time, with rapid extubation times, excellent graft function, and minimal instances of infectious or wound complications. In circumstances where large amounts of blood products are required, where a size mismatch exists, or where bowel edema is present during adult liver transplantation, temporary closure with silastic mesh is an ideal strategy.\n                      <jats:italic toggle=\"yes\">Liver Transpl 13:258\u2013265, 2007.<\/jats:italic>\n                      \u00a9 2007 AASLD.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lt.21027","type":"journal-article","created":{"date-parts":[[2007,1,26]],"date-time":"2007-01-26T18:25:23Z","timestamp":1169835923000},"page":"258-265","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":39,"title":["Temporary Silastic Mesh Closure for Adult Liver Transplantation"],"prefix":"10.1097","volume":"13","author":[{"given":"Mubeen A.","family":"Jafri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit D.","family":"Tevar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Lucia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thav","family":"Thambi-Pillai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Karachristos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Trumbull","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph F.","family":"Buell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Hanaway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve E.","family":"Woodle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Rudich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-16-20250124","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/0022-4804(76)90112-8","article-title":"Hemodynamic and respiratory alterations with increased intraabdominal pressure.","volume":"20","author":"Richardson","year":"1976","journal-title":"J Surg Res"},{"key":"R2-16-20250124","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/0022-4804(87)90041-2","article-title":"Changes in visceral blood flow with elevated intraabdominal pressure.","volume":"43","author":"Caldwell","year":"1987","journal-title":"J Surg Res"},{"key":"R6-16-20250124","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1053\/j.jvca.2003.09.010","article-title":"Association of intraoperative hypotension and pulmonary hypertension with adverse outcomes after orthotopic liver transplantation.","volume":"17","author":"Reich","year":"2003","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R7-16-20250124","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/j.1432-2277.1996.tb00853.x","article-title":"Impaired renal artery blood flow at transplantation is correlated to delayed onset of graft function.","volume":"9","author":"Lundell","year":"1996","journal-title":"Transpl Int"},{"key":"R8-16-20250124","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/00007890-199808150-00005","article-title":"Early allograft dysfunction after liver transplantation: a definition and predictors of outcome. National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database.","volume":"66","author":"Deschenes","year":"1998","journal-title":"Transplantation"},{"key":"R9-16-20250124","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S1521-6896(04)00070-9","article-title":"Issues affecting liver transplantation.","volume":"19","author":"Merritt","year":"2005","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"R10-16-20250124","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1016\/S1521-6918(04)00109-X","article-title":"Early postoperative complications following liver transplantation.","volume":"18","author":"Mueller","year":"2004","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"R11-16-20250124","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1001\/archsurg.138.7.703","article-title":"Postoperative intraabdominal pressure and renal function after liver transplantation.","volume":"138","author":"Biancofiore","year":"2003","journal-title":"Arch Surg"},{"key":"R12-16-20250124","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s00134-002-1552-7","article-title":"Intraabdominal pressure monitoring in liver transplant recipients: a prospective study.","volume":"29","author":"Biancofiore","year":"2003","journal-title":"Intensive Care Med"},{"key":"R13-16-20250124","doi-asserted-by":"crossref","first-page":"3209","DOI":"10.1016\/S0041-1345(98)00998-1","article-title":"Graft weightrecipient body weight ratio (GR ratio) in livingrelated liver transplantation for pediatric patients: abdominal wall closure in cases with a large GR ratio.","volume":"30","author":"Oikawa","year":"1998","journal-title":"Transplant Proc"},{"key":"R14-16-20250124","doi-asserted-by":"crossref","first-page":"E20","DOI":"10.1016\/S0022-3468(03)00524-4","article-title":"Use of a silastic silo for closure of the abdominal wall in a pediatric patient receiving a cadaveric split liver.","volume":"38","author":"Jones","year":"2003","journal-title":"J Pediatr Surg"},{"key":"R15-16-20250124","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.amjsurg.2004.03.007","article-title":"Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen.","volume":"188","author":"Howdieshell","year":"2004","journal-title":"Am J Surg"},{"key":"R16-16-20250124","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s001470050114","article-title":"Delayed primary closure of the abdominal wall after cadaveric and living related donor liver graft transplantation in children: a safe and useful technique.","volume":"11","author":"de Ville de Goyet","year":"1998","journal-title":"Transpl Int"},{"key":"R17-16-20250124","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1111\/j.1399-0012.1992.tb00130.x","article-title":"Temporary wound closure with expanded polytetrafluoroethylene in pediatric liver transplantation.","volume":"6","author":"Shun","year":"1992","journal-title":"Clin Transplant"},{"key":"R18-16-20250124","first-page":"255","article-title":"A new procedure for abdominal wound closure after pediatric liver transplantation: the sandwich technique.","volume":"115","author":"Machens","year":"1994","journal-title":"Surgery"},{"key":"R19-16-20250124","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1097\/00007890-199610150-00027","article-title":"2nd, et al. Use of polytetrafluoroethylene patch for temporary wound closure after pediatric liver transplantation.","volume":"62","author":"Seaman","year":"1996","journal-title":"Transplantation"},{"key":"R20-16-20250124","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1001\/archsurg.1997.01430330016002","article-title":"Planned exploration of pediatric liver transplant recipients reduces posttransplant morbidity and lowers length of hospitalization.","volume":"132","author":"Renz","year":"1997","journal-title":"Arch Surg"},{"key":"R21-16-20250124","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1097\/01.ta.0000196004.49422.af","article-title":"Complications after 344 damagecontrol open celiotomies.","volume":"59","author":"Miller","year":"2005","journal-title":"J Trauma"},{"key":"R22-16-20250124","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1046\/j.1365-2168.2002.02165.x","article-title":"Causative factors, surgical treatment and outcome of incisional hernia after liver transplantation.","volume":"89","author":"Janssen","year":"2002","journal-title":"Br J Surg"},{"key":"R23-16-20250124","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1097\/01.PRS.0000066162.18720.C8","article-title":"Recalcitrant abdominal wall hernias: long term superiority of autologous tissue repair.","volume":"112","author":"Girotto","year":"2003","journal-title":"Plast Reconstr Surg"},{"key":"R24-16-20250124","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/0163-7258(93)90067-N","article-title":"Liver cytoprotection by prostaglandins.","volume":"58","author":"Quiroga","year":"1993","journal-title":"Pharmac Ther"},{"key":"R25-16-20250124","first-page":"366","article-title":"A double blind, randomized, placebocontrolled trial of prostaglandin E1 in liver transplantation.","volume":"21","author":"Henley","year":"1995","journal-title":"Hepatology"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flt.21027","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01445473-200702000-00016","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T11:20:18Z","timestamp":1737717618000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01445473-200702000-00016"}},"subtitle":["A Safe Alternative for the Difficult Abdomen"],"short-title":[],"issued":{"date-parts":[[2007,2]]},"references-count":22,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2007]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.21027","relation":{},"ISSN":["1527-6465"],"issn-type":[{"value":"1527-6465","type":"print"}],"subject":[],"published":{"date-parts":[[2007,2]]}}}