Incisional Ventral Hernia Repair in the Liver Transplant Population-Is Biological Mesh Worth the Risk?: A Single Surgeon Experience.

Abstract

Ventral hernia repair (VHR) with mesh is the gold standard; however, the risks associated with mesh may have significant consequences for immunocompromised patients. This study seeks to evaluate outcomes of VHR in transplant recipients with and without biological mesh. A retrospective review of all VHRs for liver transplant recipients from 2016 to 2024 was conducted. Baseline characteristics, operative details, and postoperative outcomes were compared between patients undergoing VHR with and without biological mesh. Thirty-six patients were included; 20 (55.6%) underwent repair without mesh and 16 (44.4%) with biological mesh. Hernia size was larger in the mesh cohort (11.3±5.5 vs. 7.8±4.2 cm, P =0.034). The majority underwent anterior component separation, 19.4% unilateral and 38.9% bilateral. Meshes used were Ovitex (50%), Strattice (37.5%), and FlexHD (12.5%). Placement was primarily retrorectus (50%) or intraperitoneal (37.5%). Length of stay was shorter without mesh (3.5 vs. 5 d, P =0.008). Follow-up trended toward longer in the mesh cohort. Complication rates were comparable with a trend toward fewer postoperative infections without mesh (5.0% vs. 25.0%, P =0.085). All mesh infections required reoperation, and 1 patient died from complications. Recurrence rates were comparable (no mesh 10.0% vs. mesh 12.5%, P =0.813). VHR can be safely performed without mesh in select liver transplant patients, reducing the likelihood of potentially life-threatening postoperative infections without a significant increase in recurrence rates.