Robotic repair of Post-Transplant lateral incisional hernias: outcomes in complex hernia management.

INTRODUCTION: Post-transplant incisional hernias (PTIH) are a common complication in transplant patients, arising due to chronic immunosuppression, associated comorbidities, and the type of incisions used, most commonly lateral. PTIH repair is complex, frequently requiring abdominal wall reconstruction techniques, including transversus abdominis release (TAR). The robotic platform offers enhanced anatomical identification and precision, particularly in cases where the dissection plane is limited and complex, improving surgeons’ dexterity. Our objective was to evaluate the management and outcomes of robotic surgery for the repair of complex PTIH. METHODS: Patients referred to our hernia center with a history of solid organ transplantation were identified through a retrospective review. Those who underwent robotic surgery for PTIH were selected for the study. Our institution’s protocol includes preoperative rehabilitation for all patients. The decision to perform TAR was based on hernia size, the presence of loss of domain, and the patient’s anatomy. Data on patient demographics, hernia characteristics, perioperative factors, and postoperative outcomes were collected. RESULTS: A total of 24 patients were identified. 10 patients (41.7%) had a history of liver transplantation, while 14 (58.3%) had received a kidney transplant. Eight patients (33.3%) had a recurrent hernia, and 20 patients (83.3%) required TAR. The mean defect width was 16.5 cm (6.4). No intraoperative complications were observed, but one patient required conversion to open surgery. One patient (4.2%) presented to the emergency department for acute kidney injury and Clostridium difficile infection but did not require readmission. Seven patients (29.2%) experienced surgical site occurrences, including five (20.8%) with superficial seromas and two (8.3%) with hematomas. Only one (4.2%) seroma required percutaneous drainage. No hernia recurrences were noted during a follow-up of 11.2 (3.3–14.3) months. Three patients (12.5%) developed robotic port-related hernias, while one (4.2%) patient experienced chronic abdominal pain. CONCLUSION: Robotic repair of PTIH is an effective approach, demonstrating low complication rates and hernia recurrences at medium-term follow-up. The use of TAR in complex cases enhances surgical experience and dexterity, especially in lateral hernias.