Abdominal Wall Reconstruction after Orthotopic Liver Transplantation

Abstract

Introduction: Abdominal wall reconstruction (AWR) in liver transplant patients presents unique anatomical and physiologic challenges. The subcostal incision divides muscle fibers and potentially motor nerves. The patients are immunosuppressed, frequently with malnutrition and other metabolic derangements. Between 5-40% of liver transplant recipients will develop an incisional hernia. We reviewed our experience to define factors that may contribute to success. Methods: We reviewed the records of liver transplant recipients undergoing AWR by a single surgeon from 2014 to 2019. Patients with incomplete records or follow-up less than 6 months were excluded. Baseline characteristics, comorbidities, index operation characteristics, and AWR characteristics and complications were recorded. Fisher’s exact test and Mann Whitney U test were used for categorical and continuous variables, respectively. Results: Ten patients were identified meeting criteria. Median follow-up was 19 months (range 7-59). Two defects also included umbilical hernias, while one comprised a large umbilical hernia without subcostal defect. There were no early postoperative complications of AWR. There were 3 recurrences, at 12, 15, and 46 months. Recurrence was not correlated with comorbidities, index operation characteristics, or hernia or AWR characteristics. There was a non-significant increase in recurrence with anterior component separation (60% vs 0% with transversus abdominis release or no components separation, p=0.167). Conclusions: Liver transplant recipients pose challenging and diverse problems in the setting of abdominal wall reconstruction. Anterior components separation may be less effective in repairing subcostal defects, however further study is necessary to delineate this.