Management of incisional hernias in liver transplant patients: Perioperative optimization and an open preperitoneal repair using porcine-derived biologic mesh

Abstract

PURPOSE: The purpose of this study is to describe an optimal management strategy for incisional hernias in liver transplant patients. METHODS: Patients were identified who underwent open preperitoneal hernia repair for incisional hernia following liver transplantation. Perioperative management and surgical technique were described; wound complications and hernia recurrence were the primary outcomes assessed. RESULTS: A total of 17 patients met our criteria. All patients were on immunosuppression, and one patient (5.9%) had sirolimus stopped prior to the operation. One patient (5.9%) quit smoking, and two patients (11.8%) required optimization of their diabetes to have an A1c ≤7.2. Two patients (11.8%) received botulinum toxin A preoperatively due to significant loss of domain. The mean size of the biologic mesh was 818.8 ± 210 cm2, one patient (5.9%) received an anterior component separation and four (23.5%) received a panniculectomy. Postoperatively, three patients (17.7%) developed wound complications and one patient required reoperation for seroma. There were no 30-day readmissions and no hernia recurrences with mean follow-up time of 21.6 ± 11.6 months. CONCLUSION: The use of preperitoneal biologic mesh is an effective method for the management of incisional hernia in liver transplant patients; perioperative optimization and care are also influential in assuring positive outcomes for patients.