Incisional hernia repair in cirrhotic patients with ascites: a multicenter retrospective experience

Incisional hernia is a complication after abdominal surgery and is particularly challenging in patients with ascites because of increased intra-abdominal pressure, impaired wound healing, and infection risk. Evidence on surgical repair remains limited, particularly for incisional rather than umbilical hernias.

This retrospective multicenter study included 31 cirrhotic patients with ascites (22 males, 9 females; 45-72 years) who underwent incisional hernia repair between 2000 and 2025 at three tertiary General and Emergency Surgery Units. Liver disease severity was assessed using the Child-Pugh classification. Following preoperative ascites optimization, repair was performed with primary suture or mesh reinforcement. Primary outcomes were perioperative morbidity and mortality; secondary outcome was hernia recurrence.

Perioperative mortality occurred in 5 patients (16.1 %), all with advanced liver disease. Major complications occurred in 8 patients (25.8 %), while minor complications developed in 10 (32.3 %), mainly surgical site infection, seroma or hematoma, and postoperative ileus. After a median follow-up of 26 months, hernia recurrence occurred in 11 patients (35.5 %) and was higher after primary suture than mesh repair.

Elective repair is feasible in selected patients after ascites optimization. Mesh reinforcement provides greater durability when infection risk is acceptable. Patient selection and perioperative management remain essential.