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Chris E. Freise, M.D.

Chris E. Freise, M.D.

Professor & Interim Division Chief
Division of Transplant Surgery

Contact Information

(415) 353-1888 Clinical, Liver
(415) 353-1551 Clinical, Kidney and Pancreas
(415) 353-9321 Academic
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  • University of Minnesota, B.A., Chemistry, 1978-82
  • University of Minnesota, M.D., 1982-86
  • University of Minnesota, Intern, Surgery, 1986-87
  • University of Minnesota, Resident, Surgery, 1987-89
  • University of Minnesota, Resident, Surgery, 1992-93
  • University of Minnesota, Chief Resident, Surgery, 1993-94
  • University of California, San Francisco, Fellow, Surgery, 1989-92
  • University of California, San Francisco, Fellow, Transplant Surgery, 1994-96
  • American Board of Surgery, 1995
  • Bile Duct Injuries
  • Bile Duct Strictures
  • Cholangiocarcinoma (Bile Duct Cancer)
  • Choledochal Cyst Disease
  • Dialysis Access
  • Expanded Criteria Donor Kidney Transplantation
  • Fulminant Hepatic Failure
  • Hepatitis B
  • Hepatitis C
  • Hepatocellular Carcinoma (Liver Cancer)
  • Intestinal Transplantation and Rehabilitation
  • Kidney and LIver Transplantation in HIV Patients
  • Kidney Auto-transplantation
  • Kidney Transplantation
  • Laparoscopic Donor Nephrectomy
  • Laparoscopic Kidney and Liver Surgery
  • Liver Transplantation
  • Living Donor Kidney Transplantation
  • Living Donor Liver Transplantation
  • Pancreas Transplantation
  • Pediatric Kidney Transplantation
  • Pediatric Liver Transplantation
  • Polycystic Kidney Disease
  • Polycystic Liver Disease
  • Portal Hypertension
  • Surgical Shunts
  • Delivery of Immunosuppressive Agents to Organ Allografts
  • Improvement Organ Function in Deceased Donors
  • Ischemia Reperfusion Injury

Chris E. Freise, M.D. received his medical degree from the University of Minnesota where he also did his internship and residency in General Surgery. He later completed a  transplantation fellowship at UCSF.   

Highly respected by his peers, Dr. Freise was named to the list of U.S. News "Top Doctors," which denotes the top 10% of physicians within a region practicing a given specialty. He is a member of numerous professional organizations including The Transplantation Society, the International Pancreas and Islet Transplant Association, the Transplant Infectious Disease Society, the American Hepato-Pancreato-Billiary Association and the Society of University Surgeons. In addition, he recently served as the Medical Director for California Transplant Donor Network. He is also the Associate Counselor for UNOS Region 5, and a member of the UNOS Membership and Professional Standards Committee.

Dr. Freise has authored more than eighty (80) in peer-reviewed publications and five (5) book chapters. He is an accomplished researcher and clinical educator. Dr. Freise is also a frequent invited lecturer to national and international and conferences in the field.         

Dr. Friese's basic science research focuses on the delivery of immunosuppressive agents to organ allografts, ischemia reperfusion injury, and methods to improve organ function in deceased donors. His clinical research includes  a multicenter trial investigating donor and recipient outcomes following living donor liver transplantation.

  1. Fischel RJ, Freise CE, Bonser RS, Hertz MI, Jamieson SW, Dunn DL. Successful management of fulminant cytomegalovirus-induced lung injury following double-lung transplantation. Clinical Transplantation, 1988;2:331-5.
  2. Bonser RS, Fischel R, Fragomeni L, Kaye M, Burdine J, Freise C, Kriett J, Shumway S, Jamieson SW. Successful human double-lung transplantation after five and one-half hours of preservation. J Thorac. Cardiovascular Surgery, 1989;98:942-4.
  3. Burke EC, Martinez OM, Freise CE, McVicar J, Roberts JP, Ascher NL. MHC expression on human hepatocytes before and after isolation. Transplant Proc, Feb/1991;23((1 pt 2)):1428-9.
  4. Freise CE, Clemmings S, Clemens LE, Alan T, Ashby T, Ashby E, Burke EC, Roberts JP, Ascher NL. Demonstration of local immunosuppression with methylprednisolone in the sponge matrix allograft model. Transplantation, Aug/1991;52(2):318-25.
  5. Burke EC, Orloff SL, Freise CE, Macho JR, Schecter WP. Wound healing after anorectal surgery in human immunodeficiency virus-infected patients. Arch Surg, Oct/1991;126(10):1267-70; discussion 1270-1.
  6. Liu T, Freise CE, Ferrell L, Ascher NL, Roberts JP. A modified vascular "sleeve" anastomosis for rearterialization in orthotopic liver transplantation in rats. Transplantation, Jul/1992;54(1):179-80.
  7. Mühler A, Freise CE, Kuwatsuru R, Rosenau W, Liu T, Mintorovitch J, Clement O, Vexler V, Mahboubi S, Lang P. Acute liver rejection: evaluation with cell-directed MR contrast agents in a rat transplantation model. Radiology, Jan/1993;186(1):139-46.
  8. Osorio RW, Freise CE, Ascher NL, Roberts JP, Avery M, Lake JR. Orthotopic liver transplantation for end-stage alcoholic liver disease. Transplant Proc, Feb/1993;25(1 pt 2):1133-4.
  9. Osorio RW, Ascher NL, Jaenisch R, Freise CE, Roberts JP, Stock PG. Major histocompatibility complex class I deficiency prolongs islet allograft survival. Diabetes, Oct/1993;42(10):1520-8.
  10. Freise CE, Liu T, Hong K, Osorio RW, Papahadjopoulos D, Ferrell L, Ascher NL, Roberts JP. The increased efficacy and decreased nephrotoxicity of a cyclosporine liposome. Transplantation, Mar/1994;57(6):928-32.
  11. Freise CE, Liu T, Osorio RW, Ferrell L, Ascher NL, Roberts JP. Increased efficacy of CSA following rearterialization in the rat OLTX model. J Surg Res, Oct/1995;59(4):493-6.
  12. Freise CE, Liu T, Ascher NL, Roberts JP. Hepatotoxins and liver transplantation decrease pulmonary metastases in rats with hepatoma. J Surg Res, Aug/1996;64(2):198-202.
  13. Roberts JP, Liu T, Freise CE, Mielczarek J, Ferrell L, Randall H, Ascher NL. Liver transplantation improves survival of rats bearing hepatoma-3924A. J Surg Res, Sep/1996;65(1):59-62.
  14. Bretan PN Jr, Freise C, Goldstein RB, Osorio RW, Tomlanovich S, Amend W, Mathur V, Vincenti F. Immunologic and patient selection strategies for successful utilization of less than 15 kg pediatric donor kidneys-long term experiences with 40 transplants. TransplantatioN, 1997;63:233-7.
  15. Freise CE, Galbraith CA, Nikolai BJ, Ascher NL, Lake JR, Stock PG, Roberts JP. Risks associated with conversion of stable patients after liver transplantation to the microemulsion formulation of cyclosporine. Transplantation, Apr/1998;65(7):995-7.
  16. Narumi S, Osorio RW, Freise CE, Stock PG, Roberts JP, Ascher NL. Hepatic artery pseudoaneurysm with hemobilia following angioplasty after liver transplantation. Clinical Transplantation, Dec/1998;12(6):508-10.
  17. Freise CE, Narumi S, Stock PG, Melzer JS. Simultaneous pancreas-kidney transplantation: an overview of indications, complications, and outcomes. West J Med, Jan/1999;170(1):11-8.
  18. Freise CE, Ferrell L, Liu T, Ascher NL, Roberts JP. Effect of systemic cyclosporine on tumor recurrence after liver transplantation in a model of hepatocellular carcinoma. Transplantation, Feb/1999;67(4):510-3.
  19. Hirose R, Roberts JP, Quan D, Osorio RW, Freise C, Ascher NL, Stock PG. Experience with daclizumab in liver transplantation: renal transplant dosing without calcineurin inhibitors is insufficient to prevent acute rejection in liver transplantation. Transplantation, Jan/2000;69(2):307-11.
  20. Murphy EJ, Davern TJ, Shakil AO, Shick L, Masharani U, Chow H, Freise C, Lee WM, Bass NM. Troglitazone-induced fulminant hepatic failure. Acute Liver Failure Study Group. Dig Dis Sci, Mar/2000;45(3):549-53.
  21. O'Rourke RW, Osorio RW, Freise CE, Lou CD, Garovoy MR, Bacchetti P, Ascher NL, Melzer JS, Roberts JP, Stock PG. Flow cytometry crossmatching as a predictor of acute rejection in sensitized recipients of cadaveric renal transplants. Clinical Transplantation, Apr/2000;14(2):167-73.
  22. Lee CM, Carter JT, Randall HB, Hiose R, Stock PG, Melzer JS, Dafoe DC, Freise CE, Alfrey EJ. The effect of age and prolonged cold ischemia times on the national allocation of cadaveric renal allografts. J Surg Res, Jun/2000;91(1):83-8.
  23. Lee CM, Carter JT, Alfrey EJ, Ascher NL, Roberts JP, Freise CE. Prolonged cold ischemia time obviates the benefits of 0 HLA mismatches in renal transplantation. Arch Surg, Sep/2000;135(9):1016-9; discussion 1019-20.
  24. Chang GJ, Mahanty HD, Quan D, Freise CE, Ascher NL, Roberts JP, Stock PG, Hirose R. Experience with the use of sirolimus in liver transplantation--use in patients for whom calcineurin inhibitors are contraindicated. Liver Transplantation, Nov/2000;6(6):734-40.
  25. Chang GJ, Mahanty HD, Vincenti F, Freise CE, Roberts JP, Ascher NL, Stock PG, Hirose R. A calcineurin inhibitor-sparing regimen with sirolimus, mycophenolate mofetil, and anti-CD25 mAb provides effective immunosuppression in kidney transplant recipients with delayed or impaired graft function. Clinical Transplant, Dec/2000;14(6):550-4.
  26. Meng MV, Kang SM, Duh QY, Stoller ML, Freise C. Laparoscopic live donor nephrectomy at the University of California San Francisco. Clinical Transplantation, 2001;113-21.
  27. Sechser A, Osorio J, Freise C, Osorio RW. Artificial liver support devices for fulminant liver failure. Clinic Liver Dis, May/2001;5(2):415-30.
  28. Yao FY, Terrault NA, Freise C, Maslow L, Bass NM. Lamivudine treatment is beneficial in patients with severely decompensated cirrhosis and actively replicating hepatitis B infection awaiting liver transplantation: a comparative study using a matched, untreated cohort. Hepatology, Aug/2001;34(2):411-6.
  29. Jung SI, Chang GJ, Corbascio M, Potts M, Bedolli M, Ascher NI, Freise CF. Expression of intercellular adhesion molecule-1 in the cortex of preserved rat kidneys. J Surg Residency, Sep/2001;100(1):69-75.
  30. Shekarriz B, Lu H, Duh Q, Freise CE, Stoller ML. Laparoscopic nephrectomy and autotransplantation for severe iatrogenic ureteral injuries. Urology, Oct/2001;58(4):540-3.
  31. Hiramoto JS, Freise CE, Randall HR, Bretan PN, Tomlanovich S, Stock PG, Hirose R. Successful long-term outcomes using pediatric en bloc kidneys for transplantation. Am J Transplant, Apr/2002;2(4):337-42.
  32. Corbascio M, Mahanty H, Osterholm C, Qi Z, Pearson TC, Larsen CP, Freise CE, Ekberg H. Anti-lymphocyte function-associated antigen-1 monoclonal antibody inhibits CD40 ligand-independent immune responses and prevents chronic vasculopathy in CD40 ligand-deficient mice. Transplantation, Jul/2002;74(1):35-41.
  33. Meng MV, Freise CE, Kang SM, Duh QY, Stoller ML. Techniques to optimize vascular control during laparoscopic donor nephrectomy. Urology, Jan/2003;61(1):93-7; discussion 97-8.
  34. Meng MV, Freise CE, Stoller ML. Expanded experience with laparoscopic nephrectomy and autotransplantation for severe ureteral injury. J Urology, Apr/2003;169(4):1363-7.
  35. Meng MV, Freise CE, Stoller ML. Sclerosing peritonitis. Urology, Jun/2003;61(6):1257-8.
  36. Fuller TF, Kang SM, Hirose R, Feng S, Stock PG, Freise CE. Management of lymphoceles after renal transplantation: laparoscopic versus open drainage. J Urology, Jun/2003;169(6):2022-5.
  37. Stock PG, Roland ME, Carlson L, Freise CE, Roberts JP, Hirose R, Terrault NA, Frassetto LA, Palefsky JM, Tomlanovich SJ, Ascher NL. Kidney and liver transplantation in human immunodeficiency virus-infected patients: a pilot safety and efficacy study. Transplantation, Jul/2003;76(2):370-5.
  38. Gulati M, Meng MV, Freise CE, Stoller ML. Laparoscopic radical nephrectomy for suspected renal cell carcinoma in dialysis-dependent patients. Urology, Sep/2003;62(3):430-6.
  39. Freise CE, Kang SM, Feng S, Hirose R, Stock P. Excellent short-term results with steroid-free maintenance immunosuppression in low-risk simultaneous pancreas-kidney transplantation. Arch Surg, Oct/2003;138(10):1121-5; discussion 1125-6.
  40. Fuller TF, Freise CE, Serkova N, Niemann CU, Olson JL, Feng S. Sirolimus delays recovery of rat kidney transplants after ischemia-reperfusion injury. Transplantation, Dec/2003;76(11):1594-9.
  41. Abrahams HM, Meng MV, Freise CE, Stoller ML. Laparoscopic donor nephrectomy for pediatric recipients: outcomes analysis. Urology, Jan/2004;63(1):163-6.
  42. Fuller TF, Serkova N, Niemann CU, Freise CE. Influence of donor pretreatment with N-acetylcysteine on ischemia/reperfusion injury in rat kidney grafts. J Urol, Mar/2004;171(3):1296-300.
  43. Abrahams HM, Meng MV, Freise CE, Stoller ML. Pure laparoscopic right donor nephrectomy: step-by-step approach. J Endourol, Apr/2004;18(3):221-5; discussion 225.
  44. Abrahams HM, Freise CE, Kang SM, Stoller ML, Meng MV. Technique, indications and outcomes of pure laparoscopic right donor nephrectomy. J Urology, May/2004;171(5):1793-6.
  45. Greene KL, Meng MV, Abrahams HM, Freise CE, Stoller ML. Laparoscopic-assisted upper pole ureterocalicostomy using renal inversion and autotransplantation. Urology, Jun/2004;63(6):1182-4.
  46. Brennan TV, Freise CE, Fuller TF, Tomlanovich SJ Feng S. Early graft function after kidney donor kidney transplantation predicts rejection but not outcomes. American Journal of Transplantation, Jun/2004;6(4):971-9.
  47. Meng MV, Freise CE, Stoller ML. Laparoscopic nephrectomy, ex vivo excision and autotransplantation for complex renal tumors. J Urology, Aug/2004;172(2):461-4.
  48. Fuller TF, Feng S, Brennan TV, Tomlanovich S, Bostrom A, Freise CE. Increased rejection in living unrelated versus living related kidney transplants does not affect short-term function and survival. Transplantation, Oct/2004;78(7):1030-5.
  49. Posselt AM, Mahanty H, Kang SM, Stoller ML, Meng MV, Roberts JP, Freise CE. Laparoscopic right donor nephrectomy: a large single-center experience. Transplantation, Dec/2004;78(11):1665-9.
  50. Lipshutz GS, Mahanty H, Feng S, Hirose R, Stock PG, Kang SM, Posselt AM, Freise CE. BKV in simultaneous pancreas-kidney transplant recipients: a leading cause of renal graft loss in first 2 years post-transplant. American Journal of Transplant, Feb/2005;5(2):366-73.
  51. Serkova N, Fuller TF, Klawitter J, Freise CE, Niemann CU. H-NMR-based metabolic signatures of mild and severe ischemia/reperfusion injury in rat kidney transplants. Kidney Int, Mar/2005;67(3):1142-51.
  52. Carter JT, Freise CE, McTaggart RA, Mahanty HD, Kang SM, Chan SH, Feng S, Roberts JP, Posselt AM. Laparoscopic procurement of kidneys with multiple renal arteries is associated with increased ureteral complications in the recipient. Am Jornal of Transplant, Jun/2005;5(6):1312-8.
  53. Melcher ML, Carter JT, Posselt A, Duh QY, Stoller M, Freise CE, Kang SM. More than 500 consecutive laparoscopic donor nephrectomies without conversion or repeated surgery. Arch Surg, Sep/2005;140(9):835-9; discussion 839-40.
  54. Olthoff KM, Merion RM, Ghobrial RM, Abecassis MM, Fair JH, Fisher RA, Freise CE, Kam I, Pruett TL, Everhart JE, Hulbert-Shearon TE, Gillespie BW, Emond JC,. Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL Consortium. Ann Surg, Sep/2005;242(3):314-23, discussion 323-5.
  55. Yao FY, Hirose R, LaBerge JM, Davern TJ, Bass NM, Kerlan RK, Merriman R, Feng S, Freise CE, Ascher NL, Roberts JP. A prospective study on downstaging of hepatocellular carcinoma prior to liver transplantation. Liver Transpl, Dec/2005;11(12):1505-14.
  56. Fuller TF, Brennan TV, Feng S, Kang SM, Stock PG, Freise CE. End stage polycystic kidney disease: indications and timing of native nephrectomy relative to kidney transplantation. J Urol, Dec/2005;174(6):2284-8.
  57. Fuller TF, Hoff U, Rose F, Linde Y, Freise CE, Dragun D, Feng S. Effect of mycophenolate mofetil on rat kidney grafts. International Society of Nephrology, Aug/2006;70(3):570-7.
  58. Yeh B, Coakley F, Westphalen A, Joe B, Freise CE, Qayyum A, McTaggert RA, Roberts JP. Predicting biliary complications in right lobe liver transplant recipients according to distance between donor's bile duct and corresponding hepatic artery. Radiology, Jan/2007;242(1):144-51.
  59. Fisher R, Kulik L, Freise CE, Lok A, Shearon T, Emond J, Ghobrial M, Fair J, Shaked A, Trotter J, Berg C and the A2ALL Study Group. Hepatocellular Caricoma Recurrence and Death Following Living and Deceased Donor Liver Transplantation. American Journal of Transplantation, Jun/2007;7(6):1601-1608.
  60. Fuller TF, Rose F, Singleton KD, Linde Y,Freise CE, Dragun D, Niemann CU. Glutamine donor pretreatment in rat kidney transplants with severe preservation reperfusion injury. Journal Surg Res, Jun/2007;1(140):77-83.
  61. Mahanty H, Posselt A, Lipshultz G, Schneider D, Freise CE. Catheter-directed therapy for DVT after Pancreas transplantation. Clinical Transplantation, Nov/2007;21(6):748-754.
  62. Whitson JM, Stackhouse GB, Freise CE, Meng MV, Stoller ML. Laparoscopic nephrectomy, ex vivo partial nephrectomy followed by allograft renal transplantation. Urology, Nov/2007;70(5):1007.e1-3.
  63. Berg C, Gillespie B, Brown R, Abecassis M, Trotter J, Fisher R, Freise CE, Ghobrial M, Shaked A, Fair J, Everhart J. Improvement in Survival Associated with Adult-to-Adult Living Donor Liver Transplantation Gastroenterology. Gastroenterology, Dec/2007;133(6):1806-1813.
  64. Eisenberg M, Lee K, Zumrutbas A, Meng M, Freise CE, Stoller M. Long-Term Outcomes and Late Complications of Laparoscopic Nephrectomy with Renal Autotransplantation Journal of Urology, Jan/2008;179(1):240-243.
  65. Roland ME, Barin B, Carlson L, Frassetto LA, Terrault NA, Hirose R, Freise CE, Benet LZ, Ascher NL, Roberts JP, Murphy B , Keller MJ, Olthoff KM, Blumberg EA, Brayman KL, Bartlett ST, Davis CE, McCune JM, Bredt BM, Stablein DM, Stock PG. HIV- Infected Liver and Kidney Transplant Recipients: 1-and-3 Year Outcomes American Journal of Transplantation, 2008;8(2):355-365.
  66. Sung RS, Galloway J, Tuttle-Newhall JE, Mone T, Laeng R, Freise CE, Rao PS. Organ Donation and Utilization in the United States, 1997-2006 American Journal of Transplantation, 2008;8(4):922-934.
  67. Yao FY, Kerlan RK, Hirose R, Davern T, Bass N, Feng S, Peters M, Terrault N, Freise CE, Ascher N, Roberts J. Excellent Long-term Outcome Following Down-Staging of Hepatocellular Carcinoma Prior to Liver Transplantation: An Intention to Treat Analysis Hepatology, 2008;48(3):819-827.
  68. Campsen J, Blei A, Emond J, Everhart J, Freise CE, Lok A, Saab S, Wisniewski K, Trotter J. Outcomes of Living Donor Liver Transplantation for Acute Liver Failure:The A2ALL Study Liver Transplantation, 2008;14(9):1273-1280.
  69. Freise CE, Gillespie BW, Koffron A, Lok A, Pruett T, Emond J, Fair J, Fisher R, Olthoff K, Trotter J, Ghobrial M, Everhart J. Recipient Morbidity After Living and Deceased Donor Liver Transplantation: Findings from the A2ALL Retrospective Cohort Study American Journal of Transplantation, 2008;8(12):2569-2579.
  70. Ghobrial RM, Freise CE, Trotter, JF, Tong L, Ojo AO, Fair, JH, Fisher RA, Emond JC, Koffron AJ, Pruett TL, Olthoff KM. Donor Morbidity After Living Donation for Liver Transplantation Gastroenterology, 2008;135(2):468-76.
  71. Hirose R, Freise CE, Kang SM, ROberts JP, Yao FY. Laparoscopic Radiofrequency Ablation as a Bridge to Liver Transplantation for Hepatocellular Carcinoma Clinical Transplantation, 2008;XX:XX.
  72. Levine M, Feng S, Freise C. Kidney Transplant Performed after Liver Transplant: A Single Center Experience Transplantation, 2008;XX(XX):XX.
  73. Mas VR, Maluf DG, Archer KJ, Yanek K, Kong X, Kulik L, Freise CE, Olthoff KM, Ghobrial RM, Fair JH, Fisher RA. Genes Involved in Viral Carcinogenesis and Tumor Initiation in HCV-Induced HCC Molecular Med, 2009;15(3):85-94.
  74. Blasi A, Hirose R, Feiner J, Freise CE, Stock PG, Roberts JP, Niemann CU. Predictors Associated with Terminal Renal Function in Deceased Organ Donors in the Intensive Care Unit Critical Care Medicine, 2009;110(2):333-341.
  75. Breyer BN, Whitson JN, Freise CE, Meng MV. Prostate Cancer Screening and Treatment in the Transplant Population: Current Status and Recommendations Journal of Urology, 2009;181(5):2018-25.
  76. Melcher ML, Pomposelli JJ, Verbesy JE, McTaggart RA, Freise CE, Ascher NL, Roberts JP, Pomfret EA. Comparison of Biliary Complications in Adult Living Donor Liver Transplants Performed at Busy Transplant Centers Clinical Transplantation, (In Press) , XX Ed. 2009;XX(XX):XX.
  77. Chang EI, Galvez MG, Padilla BE, Freise CE, Hoffman WY. Ten year retrospective analysis of incisional hernioraphy in kidney transplant patients Archives of Surgery, (In Press) , 2009;XX:XX.
  78. Gillespie BW, Merion RM, Ortiz-Rios E, Tong L, Shaked A, Brown RS, Ojo AO, Nielson CA, Berg CL, Abecassis MM, Ashworth AS, Freise CE, Ghobrial RM, Trotter JF, Everhart JE. Comparison of patient information in the adult-to-adult living donor liver transplantation cohort study(A2ALL) and the scientific registry of transplant recipients (SRTR) database American Journal Transplantation, (In Press) , 2009;XX:XX.
  79. Melcher M, Freise CE, Ascher NL, Roberts JP. Outcomes of surgical repair of bile leaks and stricture after adult to adult living donor liver transplant Liver Transplantation, XX Ed. 2009;XX:XX.
  80. Northup PG, Abecassis MM, Englesbe MJ, Emond JC, Lee VD, Stukenborg GJ, Tong L, Berg CL; Adult-to-Adult Living Donor Liver Transplantation Cohort Study Group. Addition of adult-to-adult living donation to liver transplant programs improves survival but at an increased cost. Liver Transpl, Feb/2009;15(2):148-62.
  81. Mohebali K, Young DM, Hansen SL, Shawo A, Freise CE, Chang DS, Maa J, Harris HW. Open incisional hernia repair at an academic tertiary care medical center Archives Surgery, 9/1/2009 12:00:00 AM;144(9):848-52. 
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