Incisional hernia repair in cirrhotic patients with ascites: a multicenter retrospective experience

OBJECTIVES: Incisional hernia is a complication after abdominal surgery and is particularly challenging in patients with ascites because of increased intra-abdominal pressure, impaired wound healing, and infection risk. Evidence on surgical repair remains limited, particularly for incisional rather than umbilical hernias. METHODS: This retrospective multicenter study included 31 cirrhotic patients with ascites (22 males, 9 females; 45-72 years) who underwent incisional hernia repair between 2000 and 2025 at three tertiary General and Emergency Surgery Units. Liver disease severity was assessed using the Child-Pugh classification. Following preoperative ascites optimization, repair was performed with primary suture or mesh reinforcement. Primary outcomes were perioperative morbidity and mortality; secondary outcome was hernia recurrence. RESULTS: Perioperative mortality occurred in 5 patients (16.1 %), all with advanced liver disease. Major complications occurred in 8 patients (25.8 %), while minor complications developed in 10 (32.3 %), mainly surgical site infection, seroma or hematoma, and postoperative ileus. After a median follow-up of 26 months, hernia recurrence occurred in 11 patients (35.5 %) and was higher after primary suture than mesh repair. CONCLUSIONS: Elective repair is feasible in selected patients after ascites optimization. Mesh reinforcement provides greater durability when infection risk is acceptable. Patient selection and perioperative management remain essential.