Ventral incisional hernia repair after liver transplant using posterior component separation with transversus abdominis release

Purpose The optimal repair method for ventral incisional hernias (VIH) following orthotopic liver transplantation (OLT) has not been standardized. This study compares outcomes between use of open posterior component separation with transversus abdominis release (PCS-TAR) versus other hernia repair techniques (OHR) in patients with prior OLT from a single center. Methods Patients with a prior OLT who underwent VIH repair along their trifurcation “Mercedes Benz” incision were identified at a single center between 2007 and 2022. The primary outcome of interest was incidence of hernia recurrence between patients who were treated with PCS-TAR versus OHR. Secondary outcomes included length of hospital stay (LOHS), surgical site complications (SSC), readmissions and reoperations. P values < 0.05 were considered significant. Results Of 1,083 OLTs, there were 53 VIHs (4.9%) repaired, of which 23 (43%) underwent PCS-TAR and 30 (56%) underwent OHR. There were no statistical differences in the demographics between the groups including mean age (62.7 vs. 58.6 years, p = 0.08), male sex (69.6% vs. 73.3%, p = 0.52), and BMI > 30 kg/m 2 (21.7% vs. 30%, p = 0.5). The median time from OLT to VIH repair was 96 weeks vs. 99.3 weeks ( p = 0.35). Median follow-up was shorter in the PCS-TAR group (53 vs. 88.5 months, p < 0.01). The mean hernia width was similar in the two groups (10.98 vs. 11.88 cm, p = 0.71). VIH recurrence was 0% in PCS-TAR compared to 36.7% in OHR group ( p < 0.01). The two groups had similar incidence of SSC and LOHS. Unplanned reoperations were seen only in the OHR group (0% vs. 13.3%, p = 0.03). Conclusions PCS-TAR repair with mesh is a superior technique for VIH repair following OLT, offering a safe and effective approach with reduced hernia recurrence compared to other repair techniques in post-OLT patients.