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Safety of laparoscopic incisional hernia repair after liver transplant: a comparative study from a single institution
Agustina Altolaguirre1, Mauricio Sarmiento Cobos1, Amir Bashiri1
1Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
Introduction:
Ventral incisional hernia (VIH) is a frequent complication after liver transplantation (LT), with incidence rates up to 46%. Repair in LT recipients is particularly challenging due to immunosuppression, comorbidities, and large hernia defects. While laparoscopic incisional hernia repair (LIHR) has shown advantages in the general population, comparative outcomes in LT patients remain underexplored. This study evaluates the safety and short-term outcomes of LIHR in LT recipients versus non-transplant patients.
Methods:
A retrospective cohort study was conducted of patients undergoing LIHR at a single institution. LT recipients (2016-2025) were compared to non-transplant patients (2020-2022). Demographics, comorbidities, operative variables, and postoperative outcomes-including surgical site occurrences (SSO), infections (SSI), recurrence, readmissions, and mortality-were analyzed. Propensity score matching (1:1) adjusted for baseline differences in age, gender, BMI, diabetes, hypertension, dyslipidemia, and chronic kidney disease.
Results:
A total of 147 patients were included (42 LT; 105 non-LT). LT recipients were older, had higher rates of diabetes (38.1 vs. 14.3%) and chronic kidney disease (42.9 vs. 0.07%), and presented with larger hernia defects (median 120 vs. 27.5 cm2; p < 0.001). Operative time and length of stay were significantly longer in LT patients (116 vs. 95 min; 3.0 vs. 1.0 days). Median clinical follow-up was 0.6 months (IQR 0.5-1.5), with late events and potential recurrences identified through complete EMR review through early 2025. Complication rates were higher in LT recipients (35.7 vs. 13.3%; p = 0.0006), particularly SSOs (19.0 vs. 6.7%; p = 0.035). After matching, LT recipients still exhibited higher SSO rates (19.0 vs. 2.4%; p = 0.029), but no significant differences were found in SSI, recurrence, or readmissions. No 30-day mortality occurred in either group.
Conclusions:
LIHR in LT recipients is safe and effective, with comparable rates of infection, recurrence, and readmission to non-transplant patients. Increased SSOs in LT patients appear primarily driven by comorbidities and hernia complexity rather than surgical technique. Careful patient selection and perioperative optimization remain essential.
