Incisional hernias after liver transplantation: risk factors, treatment and outcomes

Abstract

Introduction: Incisional hernias (IH) develop in upto 20% of liver transplant(LT) recipients and can cause significant morbidity. Methods: Single-center retrospective review of patients developing IH after LT from 2003-2015 with aim of identifying risk factors and assessing outcomes. Results: 1051 patients underwent 1099 LT's during study period. 32 died within 30-days of LT and were excluded. 166/1019(16%) LT-recipients developed IH at a median of 20 mos post-LT. 73 (44%) underwent surgical repair (85% open vs. 15% lap; mesh in 90%), while 93 (56%) were managed non-operatively. Repair group had shorter median interval from LT to hernia compared to non-repair group (8 mos vs 27 mos; p<0.05). 3% (4/166) patients presented with acute incarceration requiring urgent repair. There was no difference in IH and no-IH groups in age, BMI, MELD, DM history, smoking, radiation, in-hospital stay before LT, operative time, level of assisting fellow and number of re-explorations after LT. IH group had significantly higher proportion of males (82% vs 64%; p<0.0001) and re-transplants (p=0.029) and lower incidence of acute-rejection (14% vs 24%; p=0.0060). Overall survival was significantly better in patients who developed IH compared to those who did not (91% vs. 77% at 5-years; p=0.0062). Recurrence rate after repair was 14% (10% with mesh vs 43% without mesh; 15% with open vs 9% with lap repair; p< 0.05). Conclusions: IH is a late complication after LT with male gender and re-transplantation as risk factors. Patient presenting earlier are more likely to be repaired surgically. Acute presentation is uncommon and elective repair can be undertaken in most. Mesh repair has advantage of significantly lower recurrence risk.