How-I-do-it: bottom dock eTEP with bilateral TAR for incisional hernia after liver transplantation: early outcomes and feasibility.

BACKGROUND

Incisional hernias represent a significant source of morbidity for patients following liver transplantation, and repair of these defects remains challenging. Transversus abdominis release (TAR) is a posterior component separation technique enabling wide sublay prosthetic reinforcement which is suitable for the treatment of complex incisional hernias. TAR can be used with the enhanced view totally extraperitoneal (eTEP) approach, with favorable outcomes in non-transplant patients being reported.

METHODS

This is a single center retrospective review of adult liver transplant recipients with incisional hernias who underwent robotic-assisted eTEP with bilateral TAR between December 2022 and July 2026. A comprehensive description of the surgical technique is included. Patient demographics, hernia characteristics, as well as clinical outcomes are also described.

RESULTS

Twenty-six liver transplant patients who underwent incisional hernia repair with eTEP and bilateral TAR met the inclusion criteria. Median age was 60 (IQR 55-65) and patients were predominately male (81%, n = 21). Median BMI was 28.1 (IQR 24-32) and patients were predominately ASA 3 (81%, n = 21). Median hernia length was 12 cm (IQR 9-15) and width was 15 cm (IQR 10-22). Median mesh length was 30 cm (IQR 30-35) and width was 30 cm (IQR 27-37). Mesh was fixated in 65% of patients (n = 17), predominantly with sutures (88%, n = 15). Drains were used in 92% of patients (n = 24). Median operative time was 381 min (IQR 230-517). There were no conversions to open or intraoperative complications. One patient was readmitted for a mild drain site infection which was medically managed with no other complications. Median length of stay was 2 days (IQR 1-3). Over a median follow-up period of 11 months (IQR 7-18) no patients experienced recurrence.

CONCLUSION

Patients with chevron incisional hernias following liver transplantation may be repaired with robotic-assisted eTEP with bilateral TAR. In a cohort of suitable candidates, we report favorable 30-day outcomes.