Safety of laparoscopic repair of incisional hernias in liver transplant recipients

Abstract

Introduction Incisional hernia is a common complication following liver transplantation occurring in 5%–34% of patients. Traditionally, open repair was standard due to fear of abdominal adhesions, postoperative complications and lack of experience with laparoscopic techniques. Laparoscopic incisional hernia repair (LIHR) has now become routine in non‐transplant patients, with improved postoperative outcomes. In this study, we compared outcomes after laparoscopic and open incisional hernia repair after liver transplantation at a high‐volume liver transplant center. Methods We performed a retrospective cohort study including all incisional hernia repairs performed on post‐liver transplant patients at a major liver transplant center in Australia from 2010 to 2021. Donor, recipient, intraoperative and postoperative variables were collected from the electronic medical record focusing on laparoscopic and open repairs. Results Between January 2010 and March 2021, 138 patients underwent incisional hernia repair: 40 laparoscopic (29%) and 98 open (71%). No difference in wound infection (2.5% vs. 7.7%, p = .243); wound dehiscence (.00% vs. 2.3%, p = .332) or hernia recurrence (16.3% vs. 23.0%, p = .352) was seen between treatment groups. For larger incisional hernias (>5 cm) we found that a laparoscopic repair reduced length of stay compared to open‐repair (3.89 vs. 4.57 days, p = .026). Conclusion Laparoscopic repair of larger incisional hernias reduced postoperative length of hospital stay, whilst potential advantages may include reduced wound complications and hernia recurrence. Importantly, laparoscopic repair did not increase postoperative complication rates and represents a safe technique for repair in this demographic.

Minimally Invasive Surgery in Liver Transplantation: From Living Liver Donation to Graft Implantation

“…Usage of robotic assisted surgery has been reported for the successful management of late anastomotic biliary stricture even 2 years after transplantation [88]. Incisional hernias are a very common post operative complication in open LT [109][110][111][112][113][114][115][116][117][118][119][120]. Unlike others, MIS approach for incisional hernia repair has been well documented regardless of when it occurred [111][112][113][114][115][116][117][118][119][120].…”

“…Incisional hernias are a very common post operative complication in open LT [109][110][111][112][113][114][115][116][117][118][119][120]. Unlike others, MIS approach for incisional hernia repair has been well documented regardless of when it occurred [111][112][113][114][115][116][117][118][119][120].…”