Complex abdominal wall reconstruction for management of umbilical hernia in cirrhotic patients with ascites: A video technique demonstration

The management of umbilical and ventral hernias with ascites in cirrhotic patients is considered a difficult procedure requiring a creative surgical approach. Primary repair fails in most cases, and use of synthetic mesh is controversial. In these patients we use complex abdominal wall reconstruction (CAWR) with posterior component separation and biologic mesh with sublay placement. To date, we have performed 20 of these procedures in cirrhotic patients with active ascites, 9 with umbilical hernia and 11 had incisional hernia. Seven patients underwent TIPS procedure preoperatively. In this video we show the technique used for CAWR with biological mesh in a cirrhotic patient and the postoperative results.