A series of 35 umbilical herniorraphies in patients with cirrhosis of the liver is reported. In this group there were eight significant complications (22%) and six deaths (16%). There was no evidence in this study of increased likelihood of esophageal variceal bleeding secondary to the interruption of portosystemic collaterals in the umbilical region. An aggressive surgical approach is indicated in cirrhotic patients, with umbilical herniae complicated by incarceration, strangulation, rupture, ulceration, and leakage of ascitic fluid. On the other hand it is recommended, that repair of non-complicated umbilical herniae be delayed until the cirrhosis is stabilized, ascites has diminished and nutrition has been improved. In many instances herniorrhaphy may not be necessary after disappearance of ascites.

Pure-tone audiological examination was performed in 22 neomycin-treated and untreated stable alcoholic cirrhotic patients, 10 of whom had previously undergone porta-caval shunt surgery. Severe sensori-neural hearing losses were found in the shunted group only, regardless of whether or not they had previously received neomycin. Normal audiograms were seen only among non-shunted cirrhotics. Air conduction hearing thresholds for frequencies above 3 kHz were significantly higher (poorer hearing) in the shunted compared to the non-shunted group. Thresholds were also significantly higher in shunted patients who had not received neomycin when compared to non-shunted neomycin untreated cirrhotics. These data indicate that factors other than neomycin may be contributing to the hearing loss encountered in alcoholic cirrhotics.

No abstract