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Incisional Hernia after Kidney Transplantation
Dear Colleague,
This survey is promoted by the European Society for Organ Transplantation (ESOT) — Interventional Working Group on post-kidney-transplant abdominal-wall complications (Scientific Leads: Prof. Alessandro Anselmo, Tor Vergata, Rome · Prof. Muhammad Khurram, London).
The aim is to map current practice across European LT centres on the incidence, surveillance and prevention of post-KT IH.
Estimated completion time: 12 minutes.
This survey complies with European data-protection law (GDPR). No identifying patient data are collected. Free-text comments are anonymised before analysis. Submission implies informed consent to inclusion in the aggregate dataset.
Section 1 — Respondent and centre profile
*
1.
Centre identification (kept confidential; used only for de-duplication).
(Required.)
Centre name:
Country:
City:
2.
Respondent name & e-mail (optional, for follow-up):
*
3.
Primary specialty
(Required.)
Liver transplant surgery
Kidney transplant surgery
Both
General/transplant surgery
Urology/transplant surgery
Other (please specify)
*
4.
Current role
(Required.)
Consultant/Attending
Fellow
Registrar/Resident
Professor/Academic faculty
Other (please specify)
*
5.
Years in independent practice
(Required.)
<5
5–10
11–20
>20
*
6.
Type of centre
(Required.)
University/academic
Public non-academic
Private
Mixed
*
7.
Annual kidney transplant volume at your centre per year
(Required.)
<50
50–100
101–200
>200
Section 2 — Incisional Hernia Burden & Awareness
*
8.
How significant of a problem do you consider incisional hernia after transplantation at your centre?
(Required.)
Not significant
Mild problem
Moderate problem
Major clinical problem
*
9.
Estimated incidence of incisional hernia in your practice for kidney transplantation
(Required.)
<5%
5–10%
11–20%
>20%
Unsure
*
10.
Do you routinely audit or track incisional hernia outcomes?
(Required.)
Yes
No
Planning to implement
Section 3 — Risk Assessment & Patient Selection
*
11.
Do you use a formal risk assessment strategy for incisional hernia prevention?
(Required.)
Yes
No
If yes, please specify:
*
12.
Do you have a preventative strategy for post transplant hernias?
(Required.)
Yes
No
*
13.
Which patient-related risk factors influence your preventive strategy (Select all that apply)
(Required.)
Obesity/BMI
Diabetes mellitus
Smoking
Malnutrition/sarcopenia
Previous abdominal surgery
Re-transplantation
Chronic steroid use
mTOR inhibitor use
Surgical site infection risk
Ascites
Frailty
Other (please specify)
*
14.
If you currently use prophylactic mesh, which patients would you consider for prophylactic mesh placement? (Select all that apply)
(Required.)
Obese patients
Re-do transplant
Multiple prior laparotomies
High-risk immunosuppression
Poor fascial quality
Large incision
Emergency transplant
I do not use prophylactic mesh
Other (please specify)
15.
If you don't use prophylactic mesh at the moment, which patients would you consider for prophylactic mesh placement? (Select all that apply)
Obese patients
Re-do transplant
Multiple prior laparotomies
High-risk immunosuppression
Poor fascial quality
Large incision
Emergency transplant
Other (please specify)
Section 4 — Perioperative Management
*
16.
Do you routinely modify immunosuppression around the time of IH repair?
(Required.)
No modification
Reduce mTOR-i (± switch to CNI)
Stop mTOR-i (± switch to CNI)
Reduce steroid dose
Stop steroid dose
Other (please specify)
*
17.
What abdominal closure technique is most commonly used at your centre?
(Required.)
Continuous fascial closure
Interrupted closure
*
18.
What abdominal closure technique is most commonly used at your centre?
Bite size
(Required.)
Small-bite technique (5mm)
Large-bite technique (1cm)
*
19.
Suture material most commonly used
(Required.)
Slowly absorbable monofilament
Non-absorbable monofilament
Other (please specify)
*
20.
Do you use adjunctive wound protection strategies? (Select all that apply)
(Required.)
Negative pressure wound therapy
Retention sutures
Abdominal binders
Antibiotic prophylaxis beyond standard
None
Other (please specify)
Section 5 — Mesh Use & Prevention Strategies
*
21.
Do you currently use prophylactic mesh to prevent incisional hernia?
(Required.)
Routinely
Selectively in high-risk patients
Rarely
Never
*
22.
If mesh is used, which type do you prefer?
(Required.)
Synthetic permanent mesh
Biosynthetic absorbable mesh
Biological mesh
Biosynthetic mesh
Unsure
Not applicable
*
23.
Preferred mesh position
(Required.)
Onlay
Retrorectus/sublay
Intraperitoneal
Preperitoneal
Not applicable
Other (please specify)
*
24.
What are the main barriers to prophylactic mesh adoption? (Select all that apply)
(Required.)
Infection concerns
Lack of evidence
Cost
Fear of complications
Limited training/experience
Institutional policy
Increased operative time
Concerns in immunosuppressed patients
No perceived benefit
Other (please specify)
25.
In your opinion, what level of evidence is needed before wider adoption?
Randomized controlled trials
Registry data
International guidelines
Meta-analysis
Cost-effectiveness data
Current evidence is sufficient
Section 6 — Training, Education & Research Priorities
*
26.
Have you received formal training in incisional hernia prevention strategies?
(Required.)
Yes
No
*
27.
Which educational formats would be most useful?
(Select all that apply)
(Required.)
Hands-on workshops
Webinars
Video-based training
International guidelines
Fellowship exposure
Cadaveric courses
Expert consensus meetings
Online modules
Other (please specify)
*
28.
Which areas require further research?
(Select up to 3)
(Required.)
Mesh safety in immunosuppressed patients
Optimal patient selection
Mesh type comparison
Cost-effectiveness
Closure techniques
Role of biologic/biosynthetic mesh
Impact of immunosuppression
Long-term outcomes
Quality of life outcomes
*
29.
Would your centre be interested in participating in future collaborative studies?
(Required.)
Yes
No
Maybe
30.
Additional comments or suggestions
Thank you for your time and expertise.
