Minimally invasive abdominal wall reconstruction with robotic-assisted transversus abdominis release following orthotopic liver transplant

Introduction Incisional hernias following liver transplantation are common, particularly with bi-subcostal (Mercedes) incisions. Durable repair options and perioperative outcomes in this immunosuppressed population remain poorly defined. We analyzed outcomes following minimally invasive abdominal wall reconstruction (AWR) utilizing robotic-assisted transversus abdominis release (rTAR). Methods Single-center, retrospective review of a prospectively maintained series of post-liver transplant patients referred for incisional hernia repair. Adult patients undergoing elective AWR via robotic TAR between January 2018 and July 2025 were included. Results 51 patients underwent elective hernia repair. Mean age was 61, mean BMI at repair was 29.7 kg/m 2 , and 65% were male. Mean time from transplant to repair was 20.8 months (range 7–64.9 mo). At time of repair, 27.5% were on single-agent, 58.8% on dual-agent, and 13.7% on triple-agent immunosuppression. Median hernia defect size was 144 cm 2 (24–507 cm 2 ) and median mesh size was 832 cm 2 (390–1512 cm 2 ). Mean operative time was 363 min and average length of stay was 3.8 days (2–9 days). Surgical site occurrences occurred in 4 patients (7.8%), including 2 surgical site infections. No reoperations were required. No hernia recurrences were identified at a median follow-up of 13.4 months. Conclusions Robotic-assisted AWR with rTAR provides a durable and safe approach for complex post-transplant incisional hernias. Minimally invasive component separation limits wound morbidity in the setting of immunosuppression while enabling broad sublay mesh coverage. Further long-term follow-up is ongoing.