Outcomes analysis of laparoscopic ventral hernia repair in transplant patients

Background and aim: Postoperative wound complications are minimized after laparoscopic ventral hernia repair (LVHR) while maintaining low recurrence rates and acceptable morbidity. The purpose of this study is to evaluate efficacy and safety of LVHR in patients after organ transplantation in comparison to a large cohort of nontransplantation patients after LVHR. Methods: A retrospective, institutional review board (IRB)-approved review was performed on 347 patients who underwent LVHR between July 2000 and December 2007. Results: LVHR was successfully completed in 38/38 transplantation patients (n = 21 liver, n = 5 cardiac, n = 8 kidney, n = 1 lung/kidney, n = 2 kidney/pancreas, n = 1 double lung) without conversion and in 301/309 (97.4%) nontransplant patients. Previous hernia repairs were attempted in 5/38 (13.2%) of the transplant patients and 108/309 (35.0%) of nontransplantation patients. Mean defect size was 256 cm ² (p < 0.00001) and mesh size 780 cm² (p < 0.00001) in the transplantation patients, and 140 cm² and 426 cm² in nontransplantation patients, respectively. Mean operating time was similar between the two groups (216.9 min versus 184.0 min). Perioperative complication rate was similar between groups (34.2% versus 34.3%, p = 1.0). There were three (1.0%) mesh infections and two (0.6%) mortalities in the nontransplantation patients and one mesh infection and no mortalities in the transplantation group. At mean follow-up of 20.0 (range 1.1-41) months in the transplantation group and 5.0 (range 1-38) months in the nontransplantation group, the hernia recurrence rate was 7.9% and 2.9%, respectively (p = 0.1330). Conclusion: Perioperative complication and hernia recurrence rates in transplant patients after LVHR are comparable to nontransplant patients, although the transplantation patients had significantly larger hernias. LVHR should be considered to manage ventral incisional hernias post transplantation.