Patients with Liver Insufficiency Can Safely Proceed with Elective Ventral Hernia Repair

Aldo F, Remulla D, Kimberly P, et al. Comparing Ventral Hernia Repair Outcomes in Patients with and Without Liver Insufficiency. J Am Coll Surg. December 2025.

In patients with liver insufficiency, there is a high prevalence of ventral hernias—however, the decision to proceed with elective ventral hernia repair must be balanced with the increased perioperative risk in patients with liver disease. 

Authors of this study aimed to compare ventral hernia repair outcomes in patients with and without liver insufficiency.

The patients were identified using the Abdominal Core Health Quality Collaborative, with those who underwent elective ventral hernia repair from January 2014 until December 2023 and had at least a 30-day follow up available were included in the study. To address potential treatment choice bias, propensity score matches were generated by matching patients with liver insufficiency with those without. Three matched controls were selected for each case.

A total of 36,460 patients were included in the study. After propensity score matching, there were 837 patients in the no liver insufficiency group and 279 in the liver insufficiency group. Patients with normal liver function had more mesh placed (85% versus 79%, p = 0.037) and more mesh fixation (80% versus 72%, p = 0.011). 

At 30-day follow up, there were no differences in reoperation, hernia recurrence, and overall surgical site infection, surgical site occurrence, surgical site occurrence requiring procedural intervention, pulmonary embolism, deep vein thrombosis, sepsis, urinary tract infection, pneumonia, respiratory failure, postoperative bleeding, or death. The liver insufficiency group had more readmissions (8.2% vs 4.7%, p = 0.024) and longer lengths of stay (2 days vs. 1 day, p < 0.001).

This study provides data suggesting that the liver insufficiency group demonstrated a similar postoperative risk profile compared with patients with normal liver function, and, as such, patients with liver insufficiency who present with symptomatic ventral hernias may be safely offered elective repair.