Robotic Abdominal Wall Reconstruction in Transplant Patients: A Single Institution Case Series

Solid organ transplant recipients represent a high-risk population for abdominal wall hernia repair due to chronic immunosuppression, impaired wound healing, and limited perioperative optimization. Robotic abdominal wall reconstruction (rAWR) offers a minimally invasive myofascial release approach that may reduce complications in this cohort. This study evaluates patient characteristics and short-term to midterm outcomes following rAWR in transplant recipients.

We conducted a retrospective consecutive case series of 26 solid organ transplant recipients who underwent rAWR between February 2018 and January 2025 at a single tertiary care center. Demographic, clinical, and hernia-specific variables were abstracted from institutional hernia registry and patient records. Primary outcomes included 90-d postoperative complications, surgical site occurrences, and length of stay. Recurrence was assessed during follow-up.

The cohort was predominantly male (n = 21, 81%) with a mean age of 61 y and body mass index of 33 ± 5.2 kg/m²; all patients were American Society of Anesthesiologists class III. Most were receiving ≥2 immunosuppressants (n = 23, 88%) and antiplatelet therapy (n = 20, 77%). The mean hernia dimensions were 13.7 ± 5.1 cm by 7.8 ± 4.3 cm, with M3 being the most common location (n = 21, 81%). The mean operative time was 244.8 ± 89.5 min and mean length of stay was 2.5 ± 3.1 d. Surgical site occurrences occurred in 16% of patients (n = 4). Major complications (Clavien-Dindo ≥3) occurred in 8% (n = 2), with no reoperations or mortality. At a mean follow-up of 23.8 mo, recurrence rate was 4% (n = 1).

Demonstrating acceptable morbidity and recurrence, rAWR appears safe and feasible in transplant recipients. Larger studies are needed to validate these findings and evaluate long-term durability.