Elsevier

Surgery

Volume 150, Issue 3, September 2011, Pages 542-546
Surgery

Original Communication
A prospective study on elective umbilical hernia repair in patients with liver cirrhosis and ascites

https://doi.org/10.1016/j.surg.2011.02.026Get rights and content

Background

Patients with both cirrhosis and ascites have a 20% risk of developing umbilical hernia. A retrospective study from our center comparing conservative management of umbilical hernia with elective repair in these patients showed a significant risk of mortality as a result of hernia incarceration in conservatively treated patients. The goal of this study was to assess the safety and efficacy of elective umbilical hernia repair in these patients prospectively.

Methods

Patients with liver cirrhosis and ascites presenting with an umbilical hernia were included in this study. For all patients, the expected time to liver transplantation was more than 3 months, and they did not have a patent umbilical vein in the hernia sac. The following data were collected prospectively for all patients: Child-Pugh-Turcotte (CPT) classification, model for end-stage liver disease (MELD) score, kidney failure, cardiovascular comorbidity, operation-related complications, and duration of hospital stay. Mortality rates were registered in hospital records and verified in government records during follow-up. Mortality rates were registered in hospital records and verified in government records during follow-up. On completion of the study, a retrospective survey was performed to search for any patients who met the study inclusion criteria but were left out of the study cohort.

Results

In total, 30 patients (25 males) underwent operation at a mean age of 58 years (standard deviation [SD] ± 9 years). Of these 30 patients, 6 were classified as CPT grade A (20%), 19 (63%) as grade B, and 5 (17%) as grade C. The patients’ median MELD score was 12 (interquartile range [IQR], 8–16). In 10 (33%) of the 30 patients hernia repair was performed with mesh. The median duration of hospital stay was 3 days (IQR, 2–4). None of the patients were admitted to the intensive care unit. Postoperative complications included pneumonia and decompensation of cirrhosis (1 case each,) resulting in prolonged hospital stay for those 2 patients. After a median follow-up period of 25 months (IQR, 14–34), 2 (7%) of the 30 patients died; neither of the deaths were attributable to the umbilical hernia repair. A total of 2 patients suffered recurrence.

Conclusion

Elective umbilical hernia repair is safe and the preferred approach in cirrhotic patients with ascites.

Section snippets

Methods

Between July 2004 and May 2010, all patients in the Erasmus University Medical Center with umbilical hernia, cirrhosis, and ascites were included in this study and followed prospectively. Liver failure with cirrhosis was diagnosed on clinical, biochemical, or histologic findings. Ascites was diagnosed with ultrasonography or computed tomography, and umbilical hernia was diagnosed on clinical examination.

All patients included in the study were scheduled for elective hernia repair unless their

Patient characteristics (Table I)

A total of 30 consecutive patients (25 males, 5 females) at a median age of 58.3 years (IQR, 51–65) were included in the elective repair protocol. Of these 30 patients, 7 (23%) were classified as CPT grade A, 18 (60%) as grade B, and 5 (17%) as grade C. The median MELD score was 12 (IQR, 8–16). Of the 30 patients, 6 (20%) had an ASA score of class II, 20 (67%) were class III, and 4 (13%) were class IV. A total of 53% of the patients were on the waiting list for liver transplantation.

Comorbidities of patients in the protocol (Table II)

At the time

Discussion

In this prospective single-center study, the safety of umbilical hernia repair in cirrhotic patients with ascites was investigated in a series of 30 consecutive patients. All patients underwent operations in an elective setting. Previous retrospective studies5, 8 have demonstrated that conservative treatment of umbilical hernia in cirrhotic patients is associated with considerable morbidity and mortality. Hence, prospective series, such as this one, are needed to assess the safety and efficacy

References (23)

  • J.P. Leonetti et al.

    Umbilical herniorraphy in cirrhotic patients

    Arch Surg

    (1984)
  • Cited by (89)

    • Surgical Risk Assessment in Patients with Chronic Liver Diseases

      2022, Journal of Clinical and Experimental Hepatology
      Citation Excerpt :

      Minimally invasive alternatives like colonic stent placement in case of obstruction can be considered in high risk cases. On the contrary, elective abdominal wall surgeries like umbilical hernia repair is safer with acceptable risk even in Child class C patients.61 One study reported advance age (>65), Higher MELD (>15), low serum albumin (<3 gm/dl), massive ascites, and presence of esophageal varices as predictors of poor outcome.62

    View all citing articles on Scopus
    View full text