Laparoscopic Incisional Hernia Repair After Liver Transplantation: Long-Term Series and Literature Review

Liver transplant (LT) surgery is associated with a high occurrence of hernias, which is related to multiple factors such as body mass index (BMI), diabetes, immunosuppression, corticosteroids, and so on. Laparoscopic ventral hernia repair after LT allows rapid patient recovery with a low postoperative complication rate.

We conducted a retrospective analysis of all LTs performed since 1998 in patients who underwent laparoscopic hernia repair in our centers. Likewise, we reviewed the literature, including all published studies of the laparoscopic approach to hernia repair after LT.

Between 2002 and 2018, 37 patients underwent laparoscopic hernia repair surgery after LT. The majority were men (86%) with a mean age of 51 years (48.5-61) and a BMI of 30.4. All patients underwent laparoscopic surgery, with placement of intraperitoneal mesh with a surface area of 414 cm² fixed with nonresorbable tackers. The mean hospital stay was 2 days. Morbidity included 3 seroma (8%) and a wound infection (2%); there was no major morbidity with involvement of the liver graft. The median follow-up was 43 (18-93) months, with 2 cases of recurrence (5%). In the published literature, we found 11 articles, among which the largest series was 54 patients; however, the majority had fewer than 20 cases. In all articles, a decrease in the morbidity and mortality rates was described after this surgery and previous LT decompensation.

Laparoscopic hernia repair in patients with previous LT is safe with a low complication rate and is reproducible and therefore should be the first-choice approach.