Complex Abdominal Wall Reconstruction with Biologic Mesh for Ventral Hernia Repair in Solid Organ Transplant Recipients

Background: Ventral hernia is a common occurrence in patients undergoing solid organ transplant (SOT) and who require complex abdominal wall reconstruction (CAWR). The aim of this study was to analyze the outcomes of CAWR in SOT patients in a tertiary center. Methods: We performed a prospective cohort study in patients who underwent CAWR with biological mesh at our center from January 2016 to November 2021. As per the study protocol, all patients will be followed for 3 years. Results: During the study period, we performed CAWR in 38 SOT patients. The mean age (Standard Deviation: SD) was 61 (9.5) years and the majority were males (68%). Mean body mass index (SD) was 30.3 (5.5) kg/m2 and hernia repair was performed electively in 33 patients. The majority (82%) of the hernias were less than class 2 with a median mesh size (interquartile range) of 600 (400-800) cm2. Seventy-nine percent of patients were liver transplant recipients and the mesh was placed sub-lay (retro-rectus) (82%); the most common technique was posterior component separation (82%). Five patients (13.2%) had surgical site infection and 4 (10.5%) had unplanned reoperations. None of the patients died postoperatively and the 30-day readmission rate was 21%. Three patients (7.9%) had recurrence during follow-up and all of them underwent reoperation. Conclusions: Complex abdominal wall reconstruction (CAWR) using biologic mesh for solid organ transplant patients with ventral hernia is safe and has low recurrence when performed by a dedicated CAWR team.