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World J Meta-Anal. Mar 18, 2026; 14(1): 113251
Published online Mar 18, 2026. doi: 10.13105/wjma.v14.i1.113251
Published online Mar 18, 2026. doi: 10.13105/wjma.v14.i1.113251
Mercedes incision and risk of incisional hernia following liver transplantation: A systematic review
Subba Rao V Kanchustambam, Department of Hepatobiliary Surgery, East Lancashire Hospitals NHS Trust, Blackburn BB2 3HH, Blackburn with Darwen, United Kingdom
Paul A Peters, Hepatobilliary Surgery, East Lancashire Hospitals NHS Trust, Blackburn BB2 3HH, Blackburn with Darwen, United Kingdom
Harry True, Undergraduate Medical Education, University of Exeter, Exeter EX4 4PY, Devon, United Kingdom
Benjamin G Jones, EXplorists Limited Stevenage, University of Exeter, Exeter EX4 4PY, Devon, United Kingdom
Co-first authors: Subba Rao V Kanchustambam and Paul A Peters.
Author contributions: Kanchustambam SRV conceived the study idea, designed the study, and conducted the literature search with assistance from librarians, extracted data, led the manuscript writing and performed multiple revisions; Peters PA critically revised the manuscript and was the main contributor in shaping the final version of the draft; True H participated in data extraction and contributed to the initial drafting of the manuscript and early manuscript revisions; Jones BG performed statistical analysis.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest regarding the publication of this manuscript. No financial, professional, or personal relationships exist that could have influenced the work reported in this paper.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2020 Statement guidelines.
Corresponding author: Subba Rao V Kanchustambam, Consultant, Department of Hepatobiliary Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Haslingdon Road, Blackburn BB2 3HH, Blackburn with Darwen, United Kingdom.
Received: August 20, 2025
Revised: October 8, 2025
Accepted: December 11, 2025
Published online: March 18, 2026
Processing time: 202 Days and 17.9 Hours
Revised: October 8, 2025
Accepted: December 11, 2025
Published online: March 18, 2026
Processing time: 202 Days and 17.9 Hours
Core Tip
Core Tip: This systematic review and meta-analysis of 2965 liver transplant recipients demonstrates that the Mercedes incision increases the risk of incisional hernia compared with Chevron or J-shaped incisions. The midline extension inherent to the Mercedes approach may contribute to fascial weakness. Technical factors such as two-layer closure and use of non-absorbable sutures may reduce this risk. Incision choice should be individualized to balance optimal surgical exposure with preservation of long-term abdominal wall integrity.