Preview

Transplantologiya. The Russian Journal of Transplantation

Advanced search

Incisional hernias after liver transplantation

https://doi.org/10.23873/2074-0506-2026-18-2-185-193

Abstract

Background. One of the late complications of liver transplantation is postoperative hernia of the abdominal wall, which occurs in 5–46% of recipients. An incisional hernia reduces the quality of life, and is accompanied by various complications, such as adhesive disease, intestinal passage disorder, entrapment. In addition to other factors affecting the formation of an abdominal scar, traumatic surgical approaches are reviewed as predictors of herniation.

Material and methods. The results of treatment of 77 recipients after liver transplantation in the period 2018-2025 were evaluated. Related living donor transplantation was performed in 5 and cadaveric one in 72 patients. J-shaped approach was provided to 75 (97.4%) and “Mercedes” was used in 2 (2.59%) recipients.

Results. An incisional hernia of the abdominal wall complicated the late postoperative period in 38.9% of cases. Hernial defect was diagnosed 0.5–7 years after transplantation, and in 50% of cases, the diagnosis of incisional hernia was made within 6 to 12 months after surgery. The locus minoris resistentiae of the J-shaped access is the white line and angle of the postoperative scar, where hernial defects appear more often.

Conclusion. One of the factors of herniation after liver transplantation is the multidirectional, relatively traumatic J-approach, which implies the optimal methods for strengthening "weak" points or the use of other, mainly transverse approaches.

About the Authors

S. E. Grigoriev
Irkutsk Regional Clinical Hospital; Irkutsk State Medical University
Russian Federation

Sergei E. Grigorev, Assoc. Prof., Cand. Sci. (Med.), Surgeon, Department of Portal Hypertension; Associate Professor of Hospital Surgery Department

100 Yubileyniy St., Irkutsk 664049;

1 Krasnogo Vosstaniya St., Irkutsk 664003



D. V. Savosin
Irkutsk Regional Clinical Hospital
Russian Federation

Denis V. Savosin, Surgeon, Department of Portal Hypertension

100 Yubileyniy St., Irkutsk 664049



A. V. Novozhilov
Irkutsk Regional Clinical Hospital; Irkutsk State Medical University
Russian Federation

Alexandr V. Novozhilov, Assoc. Prof., Cand. Sci. (Med.), Head of the Department of Portal Hypertension

100 Yubileyniy St., Irkutsk 664049;

1 Krasnogo Vosstaniya St., Irkutsk 664003



G. A. Bersenev
Irkutsk Regional Clinical Hospital; Irkutsk State Medical University
Russian Federation

Gleb A. Bersenev, Cand. Sci. (Med.), Surgeon, Department of Portal Hypertension; Assistant Lecturer of Hospital Surgery Department

100 Yubileyniy St., Irkutsk 664049;

1 Krasnogo Vosstaniya St., Irkutsk 664003



R. I. Shcherbakov
Irkutsk Regional Clinical Hospital
Russian Federation

Roman I. Shcherbakov, Surgeon, Department of Portal Hypertension

100 Yubileyniy St., Irkutsk 664049



References

1. Gautier SV, Khomyakov SM. Organ donation and transplantation in the Russian Federation in 2024. 17th Report from the Registry of the Russian Transplant Society. Russian Journal of Transplantology and Artificial Organs. 2025;27(3):8–32 (In Russ.). https://doi.org/10.15825/1995-1191-2025-3-8-32

2. Jin S, Wei X, Wang X, Zhang W, Wang C, Kang Y, et al. Risk factors of surgical site infection in liver transplantation recipients: a systematic review and meta-analysis. J Hosp Infect. 2025;164:34–42. PMID: 40803380 https://doi.org/10.1016/j.jhin.2025.07.013

3. Kondrashkin AS, Pinchuk AV, Yartsev PA, Dmitriev IV, Oranskiy AV, Khubutiya MSh. Prosthetic repair of the anterior abdominal wall in patients after solid organ transplantation: The experience of N.V. Sklifosovsky Research Institute for Emergency Medicine. Transplantologiya. The Russian Journal of Transplantation. 2017;9(2):101–107. (In Russ.). https://doi.org/10.23873/2074-0506-2017-9-2-101-107

4. Kniepeiss D, Waha JE, Auer T, Berghold A, Schemmer P. PRevention of INCisional hernia after liver transplantation (PRINC trial): study protocol for a randomized controlled trial. Trials. 2019;20(1):371. PMID: 31221206 https://doi.org/10.1186/s13063-019-3477-2

5. Butler JR, O'Brien DC, Kays JK, Kubal CA, Ekser B, Fridell JA, et al. Incisional hernia after orthotopic liver transplantation: a systematic review and meta-analysis. Transplant Proc. 2021;53(1):255–259. PMID: 32532557 https://doi.org/10.1016/j.transproceed.2020.03.019

6. Ferri JVV, Dick SM, Grezzana-Filho TJM, Feier FH, Prediger L, Lazzaretti GS, et al. Early incisional hernia after liver transplantation: risk factors and hernia repair results. Arq Bras Cir Dig. 2022;35:e1698. PMID: 36350959 https://doi.org/10.1590/0102-672020220002e1698

7. Strzelczyk JM. Comments to "PRevention of INCisional hernia after liver transplantation (PRINC trial): study protocol for a randomized controlled trial". Trials. 2020;21(1):165. PMID: 32046755 https://doi.org/10.1186/s13063-020-4053-5

8. Fortelny RH, Baumann P, Thasler WE, Albertsmeier M, Riedl S, Steurer W, et al. Effect of suture technique on the occurrence of incisional hernia after elective midline abdominal wall closure: study protocol for a randomized controlled trial. Trials. 2015;16:52. PMID: 25887884 https://doi.org/10.1186/s13063-015-0572-x

9. Heger P, Pianka F, Diener MK, Mihaljevic AL. Aktuelle studienlage zum bauchdeckenverschluss: klassische nahttechniken [Current standards of abdominal wall closure techniques: conventional suture techniques]. Chirurg. 2016;87(9):737–743. (In German). PMID: 27392763 https://doi.org/10.1007/s00104-016-0231-0

10. Lykoudis PM, Davidson BR. An invited commentary on "incisional hernia after liver transplantation: risk factors, management strategies and long-term outcomes of a cohort study". Int J Surg. 2020;80:40. PMID: 32574753 https://doi.org/10.1016/j.ijsu.2020.06.020

11. Piazzese E, Montalti R, Beltempo P, Bertelli R, Puviani L, Pacilè V, et al. Inci-dence, predisposing factors, and results of surgical treatment of incisional hernia after orthotopic liver transplantation. Transplant Proc. 2004;36(10):3097–3098. PMID: 15686704 https://doi.org/10.1016/j.transproceed.2004.10.047

12. Garmpis N, Spartalis E, Schizas D, Patsouras D, Damaskos C, Spartalis M, et al. Incisional hernias post liver transplantation: current evidence of epidemiology, risk factors and laparoscopic versus open repair. a review of the literature. In Vivo. 2019;33(4):1059–1066. PMID: 31280193 https://doi.org/10.21873/invivo.11574

13. Gómez R, Hidalgo M, Marques E, Marin L, Loinaz C, Gonzalez I, et al. Incidence and predisposing factors for incisional hernia in patients with liver transplantation. Hernia. 2001;5(4):172–176. PMID: 12003043 https://doi.org/10.1007/s10029-001-0032-2

14. Maki H, Kim BJ, Kawaguchi Y, Fernandez-Placencia R, Haddad A, Panettieri E, et al. Incidence of and risk factors for incisional hernia after hepatectomy for colorectal liver metastases. J Gastrointest Surg. 2023;27(11):2388–2395. PMID: 37537494 https://doi.org/10.1007/s11605-023-05777-8

15. Donataccio M, Genco B, Donataccio D. Right subcostal incision in liver transplantation: prospective study of feasibility. Transplant Proc. 2006;38(4):1109–1110. PMID: 16757279 https://doi.org/0.1016/j.transproceed.2006.03.044

16. Leshchishin YM, Savostyanov IV. Transversal laparotomy: validity of application in surgical practice and technical features of realization. Current issues in modern surgery: collection of scientific and practical articles. Krasnoyarsk, March 14–15, 2018. Krasnoyarsk: Verso Publ; 2018. p. 309–312. (In Russ.) Available at: https://www.elibrary.ru/download/elibrary_32707901_48700387.pdf [Accessed March 19, 2026].

17. DeAngelo N, Perez AJ. Hernia prevention: the role of technique and prophylactic mesh to prevent incisional hernias. Surg Clin North Am. 2023;103(5):847–857. PMID: 37709391 https://doi.org/10.1016/j.suc.2023.04.021


Review

For citations:


Grigoriev S.E., Savosin D.V., Novozhilov A.V., Bersenev G.A., Shcherbakov R.I. Incisional hernias after liver transplantation. Transplantologiya. The Russian Journal of Transplantation. 2026;18(2):185-193. https://doi.org/10.23873/2074-0506-2026-18-2-185-193

Views: 168

JATS XML


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-0506 (Print)
ISSN 2542-0909 (Online)