Management in patients with liver cirrhosis and an umbilical hernia

• Published in: Surgery Vol. 142; no. 3; pp. 372 - 375
• Main Authors: Marsman, Hendrik A., MD, Heisterkamp, Joos, MD, PhD, Halm, Jens A., MD, PhD, Tilanus, Hugo W., MD, PhD, Metselaar, Herold J., MD, PhD, Kazemier, Geert, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2007; Elsevier
• Subjects: Aged; Ascites - etiology; Ascites - surgery; Biological and medical sciences; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hernia, Umbilical - etiology; Hernia, Umbilical - surgery; Humans; Incidence; Liver Cirrhosis - complications; Liver Cirrhosis - surgery; Liver Transplantation - methods; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Recurrence; Retrospective Studies; Risk Factors; Surgery; Treatment Outcome; Human; Medicine; Cirrhosis; Clinical management; Treatment; Abdominal disease; Surgery; Digestive diseases; Hepatic disease; Umbilical hernia; Patient
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2007.05.006

Background Optimal management in patients with umbilical hernias and liver cirrhosis with ascites is still under debate. The objective of this study was to compare the outcome in our series of operative versus conservative treatment of these patients. Methods In the period between 1990 and 2004, 34 patients with an umbilical hernia combined with liver cirrhosis and ascites were identified from our hospital database. In 17 patients, treatment consisted of elective hernia repair, and 13 were managed conservatively. Four patients underwent hernia repair during liver transplantation. Results Elective hernia repair was successful without complications and recurrence in 12 out of 17 patients. Complications occurred in 3 of these 17 patients, consisting of wound-related problems and recurrence in 4 out 17. Success rate of the initial conservative management was only 23%; hospital admittance for incarcerations occurred in 10 of 13 patients, of which 6 required hernia repair in an emergency setting. Two patients of the initially conservative managed group died from complications of the umbilical hernia. In the 4 patients that underwent hernia correction during liver transplantation, no complications occurred and 1 patient had a recurrence. Conclusions Conservative management of umbilical hernias in patients with liver cirrhosis and ascites leads to a high rate of incarcerations with subsequent hernia repair in an emergency setting, whereas elective repair can be performed with less morbidity and is therefore advocated.