Oxford transplant centre carries out UK's first abdominal wall transplant

The UK’s first successful abdominal wall transplant operations in conjunction with an intestinal transplant, led by consultant plastic surgeon and BAPRAS member Henk Giele, and transplant surgeons, Professor Friend and Anil Vaidya, has been carried out in Oxford.

Since June 2012, ten of these operations have been performed at the Churchill Hospital, as part of the intestinal transplant programme at the Oxford University Hospitals NHS Trust, led by Professor Peter Friend and Mr Anil Vaidya. The operations use pioneering plastic surgery techniques to enable an increasing number of patients to undergo successful closure of the abdominal wall after bowel transplantation, thus transforming their quality of life.

Every year, approximately 25 to 30 people require small bowel transplant operations. Half of these patients may need an abdominal wall transplant because of the poor quality of their native abdominal wall muscle and skin due to multiple operations. Furthermore there is a loss of abdominal space due to contracture of the muscle of the abdominal wall around a smaller volume of bowel.

Henk Giele said:
“An intestinal transplant is both life-saving and life creating. It helps to solve extremely difficult living conditions for patients, many of whom have spent years unable to eat solid food leaving them completely reliant on intravenous feeding for up to 18 hours a day. For these people, being able to eat and taste again is a revelation, so this is truly transformative surgery.”

For patients suffering from severe abdominal scarring following congenital bowel disorders or intestinal failure, an abdominal wall transplant is critical in the overall success of a bowel transplant. Traditionally the transplanted bowel is supported by synthetic mesh and the surgery site may have to be left open due to the lack of skin cover. This may have to be secondarily skin grafted and has a higher chance of problems related to infection, longer hospital stay, and wound breakdown. By replacing the abdominal wall at the same time as the bowel, it allows creates space for the bowel to be transplanted, preventing it from becoming squeezed and ensuring that the abdomen can be closed following the transplant procedure.

Because the transplant is entirely dependent on the availability of abdominal wall donations, more people are being encouraged to sign up as donors in order to increase the availability and provision of surgery.

Plastic surgeons are ideally placed to innovate in this area given their microsurgical reconstructive and creative expertise.

Henk continues:
“Whilst our progress over the past year is hugely exciting, we want to raise awareness that this type of surgery is now possible, as we are reliant on the generosity of donors for transplant procedures to go ahead. The success of these first operations has been made possible through close collaboration between all transplant surgeons, anesthetic staff, donor coordinators, as well as the NHS Blood and Transplant Unit. 

“Our work in the intestinal transplant programme has also paved the way for further pioneering surgical procedures and innovative reconstructions using transplanted tissue. Over the past few months for example, we’ve carried out the world’s first abdominal muscle transplant and forearm tissue transplant.

“We’re fortunate here in Oxford that we work closely with our transplant colleagues and transplant teams to develop and implement these practices here in the UK.”