Incisional hernia repair following liver transplantation: A meta-analysis

Incisional hernia (IH) is a common complication following liver transplantation (LT), contributing to significant morbidity and impaired quality of life. The interplay of transplant-specific factors, patient comorbidities, surgical complexity, and immunosuppression presents considerable challenges in hernia repair, often accompanied by substantial risks.

To assess the incidence, risk factors, and outcomes of IH repair in LT recipients.

A systematic literature search was conducted across MEDLINE, EMBASE, Scopus, CINAHL, the Cochrane Library, Google Scholar, and PubMed, yielding 493 results. In accordance with PRISMA guidelines, 39 studies reporting on IH following LT were included in the final analysis. Studies involving paediatric populations, hernias unrelated to transplant incisions, living liver donors, non-LT, and multi-organ transplants were excluded. Meta-analysis was performed using Cochrane RevMan software. The study has been registered with PROSPERO (CRD42024563398).

A review of 39 studies revealed incidence of post-LT IH ranging from 1.7% to upto 42.8%. Pooled analysis showed comparable demographics among groups and post-LT IH incidence was higher in older age recipients [mean difference (MD) = 2.39, 95%CI: 1.15-3.63, P < 0.001], male gender (relative risk = 1.42, 95%CI: 1.18-1.72, P < 0.001), high body mass index (BMI) (MD = 1.06, 95%CI: 0.82-1.29, P < 0.001), Mercedez-Benz incision type [odds ratio (OR) = 0.45, 95%CI: 0.21, 0.96, P = 0.04], and need for re-laparotomy (OR = 2.49, 95%CI: 1.05-5.93, P = 0.04). No significant differences were found in recurrence rates or wound complications between open and laparoscopic IH repairs.

Older recipient age, male gender, high BMI, Mercedes-Benz incision, and re-laparotomy after LT are significant risk factors for IH. In contrast, model for end-stage liver disease score, pre-LT ascites, acute rejection, and mammalian target of rapamycin inhibitor therapy do not appear to influence IH development. While open repair remains the predominant approach post-LT, no significant differences in recurrence or wound complication rates have been observed between open and laparoscopic repairs. However, open repair is associated with a shorter operative time.