Ann Surg Treat Res.  2015 Aug;89(2):87-91. 10.4174/astr.2015.89.2.87.

The repair of umbilical hernia in cirrhotic patients: 18 consecutive case series in a single institute

• Yu BC
• Chung M
• Lee G

• KMID: 2166976
• DOI: http://doi.org/10.4174/astr.2015.89.2.87

Abstract

PURPOSE
Traditionally, the surgical repair of umbilical hernia in cirrhotic patients with ascites is avoided because of a significant recurrence rate and perioperative morbidity/mortality. However, recent reports recommend early elective surgery in these patients because surgery-related complications can be reduced with minimally invasive surgery and development of perioperative patient care. The current study was conducted to analyze safety and feasibility of umbilical hernia repairs performed in a single institute.
METHODS
A single center retrospective analysis of patients' data was conducted. Eighteen patients with umbilical hernia accompanied by liver cirrhosis underwent hernia repair in the period between 2005 and 2012. The charts of these patients were reviewed and demographic data, postoperative complications, and recurrence were recorded.
RESULTS
Eleven males and seven females with a mean age of 62.9 years were analyzed. Two of the patients were classified as Child's class A, 11 as Child's class B, and five as Child's class C. Four patients underwent emergency surgery because of perforations in the hernia sac in two cases and incarcerated hernias in the other two cases. Of the 18 patients who underwent surgery, four (22%) experienced a recurrence, three (17%) developed edema at the surgical sites, one (5%) experienced hepatic coma, and one (5%) showed postoperative variceal hemorrhage. All of these events occurred after emergency surgery.
CONCLUSION
In contrast to traditional concepts, early and elective repair of umbilical hernia can be performed easily and safely in cirrhotic patients.

Keyword

Hernia; Ascites; Laparoscopy

MeSH Terms

Ascites
Edema
Emergencies
Female
Hemorrhage
Hepatic Encephalopathy
Hernia
Hernia, Umbilical*
Herniorrhaphy
Humans
Laparoscopy
Liver Cirrhosis
Male
Patient Care
Postoperative Complications
Recurrence
Retrospective Studies
Surgical Procedures, Minimally Invasive

Figure

• 

  Fig. 1 (A) Gross appearance of umbilical hernia in cirrhotic patient. (B) Typical CT finding of umbilical hernia. (C) Laparoscopic intraperitoneal onlay mesh repair, mesh fixation using fascial clsoure and endo-stapler.

Reference

1. Belghiti J, Durand F. Abdominal wall hernias in the setting of cirrhosis. Semin Liver Dis. 1997; 17:219–226.

2. Shlomovitz E, Quan D, Etemad-Rezai R, McAlister VC. Association of recanalization of the left umbilical vein with umbilical hernia in patients with liver disease. Liver Transpl. 2005; 11:1298–1299.

3. Arroyo A, Garcia P, Perez F, Andreu J, Candela F, Calpena R. Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults. Br J Surg. 2001; 88:1321–1323.

4. Lemmer JH, Strodel WE, Knol JA, Eckhauser FE. Management of spontaneous umbilical hernia disruption in the cirrhotic patient. Ann Surg. 1983; 198:30–34.

5. Marsman HA, Heisterkamp J, Halm JA, Tilanus HW, Metselaar HJ, Kazemier G. Management in patients with liver cirrhosis and an umbilical hernia. Surgery. 2007; 142:372–375.

6. O'Hara ET, Oliai A, Patek AJ Jr, Nabseth DC. Management of umbilical hernias associated with hepatic cirrhosis and ascites. Ann Surg. 1975; 181:85–87.

7. Belli G, D'Agostino A, Fantini C, Cioffi L, Belli A, Russolillo N, et al. Laparoscopic incisional and umbilical hernia repair in cirrhotic patients. Surg Laparosc Endosc Percutan Tech. 2006; 16:330–333.

8. Gonzalez R, Mason E, Duncan T, Wilson R, Ramshaw BJ. Laparoscopic versus open umbilical hernia repair. JSLS. 2003; 7:323–328.

9. Jarsaillon P. Laparoscopic treatment of an umbilical hernia using a new composite mesh. Hernia. 2000; 4:517–521.

10. Hansen JB, Thulstrup AM, Vilstup H, Sørensen HT. Danish nationwide cohort study of postoperative death in patients with liver cirrhosis undergoing hernia repair. Br J Surg. 2002; 89:805–806.

11. Sarit C, Eliezer A, Mizrahi S. Minimally invasive repair of recurrent strangulated umbilical hernia in cirrhotic patient with refractory ascites. Liver Transpl. 2003; 9:621–622.

12. Baron HC. Umbilical hernia secondary to cirrhosis of the liver: complications of surgical correction. N Engl J Med. 1960; 263:824–828.

13. Lemmer JH, Strodel WE, Eckhauser FE. Umbilical hernia incarceration: a complication of medical therapy of ascites. Am J Gastroenterol. 1983; 78:295–296.

14. Pescovitz MD. Umbilical hernia repair in patients with cirrhosis: no evidence for increased incidence of variceal bleeding. Ann Surg. 1984; 199:325–327.

15. McKay A, Dixon E, Bathe O, Sutherland F. Umbilical hernia repair in the presence of cirrhosis and ascites: results of a survey and review of the literature. Hernia. 2009; 13:461–468.

16. Kirkpatrick S, Schubert T. Umbilical hernia rupture in cirrhotics with ascites. Dig Dis Sci. 1988; 33:762–765.

17. Maniatis AG, Hunt CM. Therapy for spontaneous umbilical hernia rupture. Am J Gastroenterol. 1995; 90:310–312.

18. Arnaud JP, Cervi C, Tuech JJ, Cattan F. Surgical treatment of post-operative incisional hernias by intra-peritoneal insertion of a Dacron mesh. Hernia. 1997; 1:97–99.

19. LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc. 1993; 3:39–41.

20. Marchal F, Brunaud L, Sebbag H, Bresler L, Tortuyaux JM, Boissel P. Treatment of incisional hernias by placement of an intraperitoneal prosthesis: a series of 128 patients. Hernia. 1999; 3:141–147.

21. Mutter D, Rodeheaver G, Diemunsch P, Therin M, Moody D, Raffaeli M. A new composite mesh (collagen-polyester) for intra-abdominal laparoscopic hernia repair. Surg Endosc. 1998; 12:595.

22. Itani KM, Neumayer L, Reda D, Kim L, Anthony T. Repair of ventral incisional hernia: the design of a randomized trial to compare open and laparoscopic surgical techniques. Am J Surg. 2004; 188:6A Suppl. 22S–29S.

23. Belghiti J, Desgrandchamps F, Farges O, Fekete F. Herniorrhaphy and concomitant peritoneovenous shunting in cirrhotic patients with umbilical hernia. World J Surg. 1990; 14:242–246.

24. Leonetti JP, Aranha GV, Wilkinson WA, Stanley M, Greenlee HB. Umbilical herniorrhaphy in cirrhotic patients. Arch Surg. 1984; 119:442–445.

25. Runyon BA, Juler GL. Natural history of repaired umbilical hernias in patients with and without ascites. Am J Gastroenterol. 1985; 80:38–39.