Hérnias abdominais e inguinais em pacientes cirróticos: qual é a melhor conduta?

Silva, Felipe Duarte; Andraus, Wellington; Pinheiro, Rafael Soares; Arantes-Junior, Rubens Macedo; Lemes, Marcus Paulo Lemos; Ducatti, Liliana; D’Albuquerque, Luiz Augusto Carneiro

doi:10.1590/s0102-67202012000100012

Cited by 17 publications

(11 citation statements)

References 24 publications

(22 reference statements)

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“…Patients' characteristics are shown in Table 2. Mean patients’ age was 65.52 ± 11.06 years and median MELD was 12 [[6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24]]. All variables were similar between the two groups, except for number of patients in LT waiting list, which was higher in the elective hernia repair groups.…”

Section: Resultsmentioning

confidence: 99%

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Abdominal hernias in cirrhotic patients: Surgery or conservative treatment? Results of a prospective cohort study in a high volume center: Cohort study

Pinheiro

Andraus

Waisberg

et al. 2020

Annals of Medicine and Surgery

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BackgroundSurgical treatment of abdominal hernias in cirrhotics is often delayed due to the higher morbidity and mortality associated with the underlying liver disease. Some patients are followed conservatively and only operated on when complications occur (“wait and see” approach). The aim of this study is to compare outcomes of cirrhotic patients undergoing conservative non-operative care or elective hernia repair.MethodsA prospective observational study including 246 cirrhotic patients with abdominal hernia was carried out. Patients were given the option to select their treatment: elective hernia repair or conservative non-operative care. Demographics, characteristics of underlying liver disease, type of hernia, complications and mortality were analyzed. During follow-up of patients who opted for the “wait and see” approach, emergency hernia repair was performed in case of hernia complications.ResultsElective hernia repair was performed in 57 patients and 189 patients were kept in conservative care, of which 43 (22.7%) developed complications that required emergency hernia repair. Elective surgery provided better five-years survival than conservative care (80% vs. 62%; p = 0.012). Multivariate analysis identified multiples hernias [Hazards Ratio (HR):6.7, p < 0.001] and clinical follow-up group (HR 3.62, p = 0.005) as risk factors for mortality. Among patients undergoing surgical treatment, multivariate analysis revealed MELD>11 (HR 7.8; p = 0.011) and emergency hernia repair (HR 5.35; p = 0.005) as independent risk factors for 30-day mortality.ConclusionsElective hernia repair offers an acceptable morbidity and ensures longer survival. “Wait and see” approach jeopardizes cirrhotic patients and should be avoided, given the higher incidence of emergency surgery due to hernia complications.

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Section: Resultsmentioning

confidence: 99%

“…Over the last decade, elective hernia surgery has been increasingly advocated for cirrhotic patients [2,12,19,20]. Modern surgical technique and perioperative care have been reported to improve morbity and mortality rates, justifying early repair before complications arise.…”

Section: Discussionmentioning

confidence: 99%

Abdominal hernias in cirrhotic patients: Surgery or conservative treatment? Results of a prospective cohort study in a high volume center: Cohort study

Pinheiro

Andraus

Waisberg

et al. 2020

Annals of Medicine and Surgery

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“…Besides the small bowel, in patients without liver diseases, the hernia may contain ovary, bladder, ureter, colon, or appendix [3]. On the other hand, in cases of cirrhotic patients, the content is mostly ascites [6]. In these cases, the transgluteal approach is preferred because it is less invasive and is easier to obtain a hermetic closure.…”

Section: Discussionmentioning

confidence: 99%

“…These patients easily decompensate and get infection, develop renal insufficiency, or worsen their liver function. The morbidity and mortality seem to be higher in urgent situations, with hernia perforation or incarceration and when infection is associated [6]. The surgical technique needs to be adapted prioritizing the hermetic closure.…”

Section: Discussionmentioning

confidence: 99%

Sciatic Hernia Mimicking Perianal Abscess in a Cirrhotic Patient

Andraus

Haddad

Ferro

et al. 2012

Case Reports in Medicine

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Abdominal hernias are very frequent in cirrhotic patients with ascites. The hernias usually present as umbilical, inguinal, incisional, or femoral. However, these patients can also develop uncommon hernias such as pelvic hernias because of pelvic floor weakness and high abdominal pressure due to ascites. We present the first case of a cirrhotic patient with ascites that developed a giant sciatic hernia mimicking a perianal abscess.

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“…Recent multiple studies showed that laparoscopic hernia repair was associated with similar short-term outcomes and lower complications compared to open repair. [3,9,10]…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in patients with liver cirrhosis accompanied by ascites

Wang

et al. 2019

Medicine

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To investigate the feasibility, efficacy, and safety of laparoscopic totally extraperitoneal (TEP) repair in patients with inguinal hernia accompanied by liver cirrhosis.Between October 2015 and May 2018, 17 patients with liver cirrhosis who underwent TEP repair were included in this study. The baseline characteristics, perioperative data, and recurrence were retrospectively reviewed.Seventeen patients with a mean duration of 18.23 ± 16.80 months were enrolled. All TEP repairs were successful without conversion to trans-abdominal pre-peritoneal (TAPP) surgery or open repair, but 4 patients had peritoneum rupture during dissection. The mean operation time was 54.23 ± 10.51 minutes for unilateral hernia and 101.25 ± 13.77 minutes for bilateral hernias. We found 2 cases with contralateral inguinal hernia and 2 cases with obturator hernia during surgery. The rate of complication was 17.65% (3/17), 2 of 3 cases were Child-Turcotte-Pugh C with large ascites. During a follow-up of 19.29 ± 9.01 months, no patients had recurrence and chronic pain, but 2 patients died because of the progression of underlying liver disease.Early and elective inguinal hernia repair is feasible and effective for patients with liver cirrhosis. TEP is a feasible and safe repair option for cirrhotic patients in experienced hands.

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Hérnias abdominais e inguinais em pacientes cirróticos: qual é a melhor conduta?

Cited by 17 publications

References 24 publications

Abdominal hernias in cirrhotic patients: Surgery or conservative treatment? Results of a prospective cohort study in a high volume center: Cohort study

Abdominal hernias in cirrhotic patients: Surgery or conservative treatment? Results of a prospective cohort study in a high volume center: Cohort study

Sciatic Hernia Mimicking Perianal Abscess in a Cirrhotic Patient

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in patients with liver cirrhosis accompanied by ascites

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