Heisterkamp et al. 1
in a recent issue of Liver Transplantation. The authors present their experience, comparing 58 consecutive patients with the classic Mercedes incision and the following 60 consecutive patients with a J-shaped incision for liver transplantation. They concluded that a J-shaped incision should be the incision of choice, reporting that wound-related morbidity was significantly higher in the Mercedes incision group (19% versus 3%, P ฯญ 0.009) and that, more importantly, there were fewer incisional hernias during follow-up in the J-shaped incision group: 4 of 60 (7%) versus 14 of 58 (24%) in the Mercedes incision group (P ฯญ 0.002). We would like to add a few comments on this topic. From 2005 to 2008, we performed 115 orthotopic liver transplants: 53 with the Mercedes incision (group A) and 62 with the J-shaped incision (group B). Major posttransplant relaparotomy was more frequent in group A versus group B (38 versus 19, respectively, P ฯฝ 0.0001). Analyzing our data, we found no differences in incisional hernias in the Mercedes incision group versus the J-shaped incision group (8 versus 6 patients, respectively, P ฯญ 0.13), despite more posttransplant relaparotomy in group A. Heisterkamp et al. describe even a slightly high number of cases (15%) with J-shaped incisions that were converted into classic Mercedes incisions because of intraoperative difficulties; in our experience, there were no conversions from a J-shaped incision into a Mercedes incision during liver transplantation. In an article by D'Angelica et al., 2 no difference is reported in terms of early wound complications, although incisional hernias occurred in 9.8% of patients with a Mercedes incision versus 4.8% of those with an extended right subcostal incision (P ฯญ 0.0001). On multivariate analysis, the incision type, along with gender, body mass index, and age, was a significant predictor of incisional hernia.