Our Summary

This research paper talks about the challenges faced during the process of closing the abdominal wall after an intestinal or multivisceral transplant. It suggests that the best practice involves a technique known as “component separation” where the abdominal wall is closed without any tension. This is often done with the use of a synthetic mesh.

In cases where this technique can’t be used, another option is the abdominal wall composite vascularized allograft transplant. This procedure involves the use of a donor’s abdominal wall with its blood supply intact.

Another method, which is gaining popularity worldwide, involves the use of the patient’s own rectus fascia (a flat band of tissue below the skin that encases the muscles). This method is simple and well accepted by patients.

The researchers have also found that the abdominal wall can be used to monitor the health of the transplanted organs like the intestine or pancreas.

Overall, the paper concludes that there are various effective methods for closing the abdominal wall after a transplant. These methods have long-term benefits and could be used in other areas like reconstructive surgery and immunology.

FAQs

  1. What are the challenges faced in intestinal and multivisceral transplants?
  2. What are the different options for abdominal wall closure following intestinal transplantation?
  3. How has the abdominal wall transplants been used in sentinel monitoring of the intestinal or pancreas allograft?

Doctor’s Tip

One tip that a doctor might tell a patient about intestinal transplant is to focus on achieving a tension-free primary closure of the abdominal wall. This can help prevent complications and promote successful healing after the transplant surgery. In some cases, techniques such as component separation or the use of a synthetic mesh may be necessary to achieve this goal. Additionally, options such as the abdominal wall composite vascularized allograft transplant or nonvascularized abdominal rectus fascia may be considered if other methods are not feasible. It is important to discuss these options with your healthcare team to determine the best approach for your individual situation.

Suitable For

Patients who are typically recommended for intestinal transplant include those with severe and irreversible intestinal failure, such as those with short bowel syndrome, inflammatory bowel disease, or congenital gastrointestinal disorders. These patients may have failed other treatments such as parenteral nutrition or intestinal lengthening procedures. Additionally, patients with complications from intestinal transplantation, such as chronic rejection or graft failure, may also be candidates for re-transplantation. Overall, patients with a poor quality of life and limited treatment options are often considered for intestinal transplant.

Timeline

  • Before intestinal transplant:
  1. Patient undergoes extensive evaluation to determine eligibility for transplant, including medical history, physical examination, imaging studies, and blood tests.
  2. Patient may wait on a transplant list for a suitable donor organ to become available.
  3. Patient receives pre-transplant medications and counseling to prepare for the surgery.
  • After intestinal transplant:
  1. Patient undergoes surgery to remove the diseased intestine and replace it with a healthy donor organ.
  2. Patient is closely monitored in the intensive care unit (ICU) post-transplant for complications and to ensure the new organ is functioning properly.
  3. Patient begins a regimen of immunosuppressive medications to prevent organ rejection.
  4. Patient undergoes rehabilitation and physical therapy to regain strength and function.
  5. Patient follows up with regular appointments with healthcare providers to monitor the success of the transplant and manage any complications.
  6. Patient may experience complications such as rejection, infection, and side effects from immunosuppressive medications.

What to Ask Your Doctor

  1. What are the potential benefits of an intestinal transplant for my specific condition?

  2. What are the risks and potential complications associated with an intestinal transplant?

  3. How long is the recovery process after an intestinal transplant and what can I expect during the recovery period?

  4. What are the long-term success rates of intestinal transplants and what factors may affect the success of the transplant?

  5. What is the process for finding a suitable donor for an intestinal transplant?

  6. What are the alternatives to an intestinal transplant and how do they compare in terms of effectiveness and risks?

  7. What is the expected outcome of the abdominal wall closure procedure following an intestinal transplant?

  8. Are there any specific dietary or lifestyle changes I will need to make following an intestinal transplant?

  9. How often will I need to follow up with my medical team after an intestinal transplant and what ongoing monitoring will be necessary?

  10. Are there any clinical trials or research studies related to intestinal transplants that I may be eligible to participate in?

Reference

Authors: Gondolesi GE, Aguirre NF. Journal: Curr Opin Organ Transplant. 2017 Apr;22(2):135-141. doi: 10.1097/MOT.0000000000000394. PMID: 28151808