Complex Abdominal Wall Reconstruction with Biologic Mesh for Ventral/Umbilical Hernias in Patients with Cirrhosis

Abstract

Introduction: Patients with cirrhosis undergoing non-liver transplant surgery have a higher risk of adverse events than those without cirrhosis. Methods: This study had retrospective and prospective components, including all cirrhotic patients at our center with complex abdominal wall reconstruction (CAWR) for ventral/umbilical hernia repair with biologic mesh between December 2016 and November 2021. Results: We studied 37 patients with cirrhosis. Their mean age was 57.2 years. 64.9% were male. The median BMI was 28.1 kg/m2. Ascites was present in 83.3% of patients. The other most common comorbidities were alcohol abuse (67.6%), hypertension (37.8%), and diabetes (24.3%). All complications in aggregate occurred in 11 patients (29.7%). Six patients (16.2%) underwent reoperation. Surgical site infection (SSI) occurred in 5 patients (13.5%). Four deaths occurred within 90 days (11.2% cumulative mortality). By 120 days, there were 5 deaths (14.2% mortality, but none due to the operation). Three predictors (mesh size ≥200 sq cm, lysis of adhesions, and VHWG grade ≥3) achieved an area under the receiver operating characteristic curve (AUROC) for SSI of 0.938 and two predictors (BMI ≥35 kg/m2 and preoperative aspirin) yielded an AUROC of 0.825 for 120-day mortality. Conclusion: Our results suggest that CAWR for ventral/umbilical hernias among cirrhotic patients is feasible given a dedicated CAWR team in collaboration with transplant surgeons and a transplant hepatologist. The rates of adverse outcomes were low or at the midpoint of the range of the study-specific estimates.