K. Maeda1, N. Charland1, M. Ha1, S.S. Ebaid1, V.G. Agopian1, D.G. Farmer1, F.M. Kaldas1 1University Of California – Los Angeles, Division Of Liver And Pancreas Transplant, Department Of Surgery, David Geffen School Of Medicine, Los Angeles, CA, USA
Introduction:
Umbilical hernias are common in patients with end-stage liver disease (ESLD) undergoing liver transplantation (LT). However, studies examining the incidence and outcomes of simultaneous umbilical hernia repair (SUHR) remain lacking. This study evaluated risk factors for preoperative umbilical hernia among LT patients and associated outcomes of SUHR.
Methods:
Adult ESLD patients who underwent primary LT (2012–2023) at a single center were retrospectively analyzed. Pre-LT umbilical hernias were diagnosed by CT scan performed within one month before LT. All SUHR were performed via primary closure. Hernia recurrence after SUHR was identified by either physical examination or radiographic imaging. Uni- and multivariate analyses were conducted to identify risk factors for umbilical hernia at the time of LT and recurrence after SUHR.
Results:
Of the 622 patients who met the inclusion criteria, 217 patients (34.9%) had an umbilical hernia at LT. Multivariate analysis identified the older recipient age (P=0.005), Hispanic ethnicity (P=0.027), alcoholic cirrhosis (P=0.027), and history of therapeutic paracentesis (P<0.001) as independent risk factors for umbilical hernia at LT. Of the 217 patients who had an umbilical hernia, 132 patients (60.8%) underwent SUHR. These patients had significantly larger hernial orifice widths (16 vs. 12 mm, P=0.003), overlying skin lesions (9.1 vs. 1.2%, P=0.016), and higher incarceration history (7.6 vs. 0%, P=0.006) than patients who did not undergo SUHR. Umbilical hernia-related post-operative complications included 2 (1.5%) cases of superficial surgical site infections and 2 (1.5%) cases of bleeding. 45 (34.1%) patients developed recurrent hernias (median postoperative interval 16 [4-35] months). Non-recurrence rates at 1, 3, and 5 years were 75.6, 63.0, and 57.1%, respectively. 36 (27.3%) patients without symptoms were followed conservatively, while 9 (6.8%) patients with symptomatic recurrence underwent re-repair (primary closure: 1, mesh repair: 8). Multivariate analysis revealed that hernial orifice width (Hazard Ratio: 1.028, 95% CI: 1.004-1.053, P=0.024) was an independent risk factor for recurrence after SUHR. Non-recurrence rates among patients with hernial orifice widths ≥30mm were significantly worse than those with <30mm (30.2 vs. 64.0% at 3 years after LT, P=0.002, Figure)
Conclusion:
This high-volume center study demonstrated a high incidence of umbilical hernias at the time of LT among high-acuity ESLD patients. SUHR resulted in an acceptable symptomatic recurrence rate with minimal complications. We identified independent risk factors for recurrence after SUHR, which may aid in the management of LT patients presenting with umbilical hernias.