Minimally invasive repair of recurrent strangulated umbilical hernia in cirrhotic patient with refractory ascites

Abstract

To repair a recurrent strangulated umbilical hernia in a cirrhotic patient with refractory ascites, we used a minimally invasive procedure. The laparoscopic repair included a release of the incarcerated small bowel loop and secure of a dual Gortex mesh onto the fascial rim. Our satisfactory long-term results should encourage surgeons to adapt this surgical approach. (Liver Transpl 2003;9: 621-622.)

Assessment of risk for non-hepatic surgery in cirrhotic patients

“…This is important since ascitic fluid infection, which may occur after surgery may affect the hernia mesh repair. The possibility of mesh migration due to the ascitic fluid can be reduced by placing the mesh in a preperitoneal space [84].…”

Editorial: Management of umbilical hernia in patients with advanced liver disease

“…8 In this issue of Liver Transplantation, Sarit, Eliezer, and Mizrahi describe laparoscopic reduction of an incarcerated bowel and placement of a mesh prosthesis to repair a recurrent hernia in a patient with cirrhosis. 9 Certain risks specific to cirrhotic patients inherent in this surgical approach were not encountered. Trocar placement in the left subcostal region must be careful to avoid an enlarged spleen.…”

“…Angulation of trocar entry, as the investigators have described, may allow the layers of the abdominal wall to overlap and obstruct a potential ascitic fistula. 9 Placement of the mesh in the preperitoneal space covered by a peritoneal flap will reduce the risks for mesh migration, bowel adhesion, and cyst formation at the umbilicus. If bleeding is encountered from umbilical varices, clip ligation of the umbilical vein in the epigastrium may allow for sufficient control to proceed with the laparoscopic approach or safely convert to the open procedure.…”

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

“…The laparoscopic approach was described also in recurrent incarcerated umbilical hernia, Child's class B, C, and refractory ascites patient [75,76].…”