Safety and effectiveness of umbilical hernia repair in patients with cirrhosis

Hew, Simon; Yu, Wenhan; Robson, Stephen C.; Starkey, Graham; Testro, Adam; Fink, Michael A; Angus, Peter W; Gow, Paul J

doi:10.1007/s10029-018-1761-9

Cited by 22 publications

(22 citation statements)

References 18 publications

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“…Hernia recurrence is also lowered by using prosthetic mesh. This might explain the low recurrence rate found in our study (2%), similar to the ones reported in others series (1,7 to 2.7%) [25,26].…”

Section: Discussionsupporting

confidence: 93%

“…Morbidity and mortality rates vary according to the degree of liver disease. In Hew et al series, they were or CTP A patients, 18.8% and 0% for CTP B and 66.7% and 4.2% for CTP C, respectively [25]. This data shows that although complications become more prevalent as liver disease advances, the outcomes are still satisfactory, and thus CTP score itself should not be a sole reason to preclude elective hernia repair.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, 32.92% of patients were at LT waitlist and one third of these underwent LT during the study. This demonstrates the recommendation that patients with advanced cirrhosis and abdominal wall hernias should be preferentially treated in specialized centers who also offer transplantation [21,25]. Hernia diagnoses in patients with portal hypertension may be tricky.…”

Section: Discussionmentioning

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: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…Patients who are candidates for LT in the near future should defer hernia repair until during or after transplantation (162). For patients in whom transplantation is not imminent (i.e., low MELD), elective herniorrhaphy may be offered in select patients, after careful consideration of its risks and benefits in comparison to nonoperative management, with a possible need for an emergent operation (163)(164)(165)(166). Clinically apparent ascites should be controlled prior to elective herniorrhaphy, for which laparoscopic approaches are preferred (167).…”

Section: Abdominal Herniasmentioning

confidence: 99%

“…(162) For patients in whom transplantation is not imminent (i.e., low MELD), elective herniorrhaphy may be offered in select patients after careful consideration of its risks and benefits in comparison with nonoperative management, with a possible need for an emergent operation. (163)(164)(165)(166) Clinically apparent ascites should be controlled before elective herniorrhaphy, for which laparoscopic approaches are preferred. (167) The use of prosthetic mesh may reduce the recurrence rate but may increase the risk of infections and other complications.…”

Section: Abdominal Herniasmentioning

confidence: 99%

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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This is a comprehensive guidance on the diagnosis, evaluation, and management of ascites and hepatorenal syndrome in patients with chronic liver disease from the American Association for the Study of Liver Diseases (AASLD). It replaces the prior AASLD guideline on the same topic published in 2012 (1).This AASLD Guidance provides a data-supported approach to the management of ascites and hepatorenal syndrome. It differs from AASLD Guidelines, which are supported by systematic reviews of the literature, formal rating of the quality of the evidence and strength of the recommendations. In contrast, this Guidance was developed by consensus of an expert panel and provides guidance statements based on comprehensive review and analysis of the literature on the topics, with oversight provided by the AASLD Practice Guidelines Committee. The AASLD Practice Guidelines Committee chose to perform a Guidance on this topic because a sufficient number of randomized controlled trials were not available to support meaningful systematic reviews and meta-analyses. A. Introduction Burden of Cirrhotic Ascites and Hepatorenal SyndromeHepatic decompensation, defined by ascites, hepatic encephalopathy, and portal hypertensive gastrointestinal bleeding, is an important landmark in the natural history of cirrhosis (2). Ascites is commonly the first decompensation-defining event, with 5%-10% of patients with compensated cirrhosis developing ascites per year (3). The development of ascites is associated with a reduction in 5-year survival from 80% to 30% (4), which is due in part to patients with ascites being prone to additional complications such as bacterial infections, electrolyte abnormalities, hepatorenal syndrome (HRS) and nutritional imbalances, and consequently, further clinical decline (5). Patients with cirrhosis who develop clinically significant ascites and related complications should be considered for referral for liver transplantation (LT) evaluation and, where appropriate, palliative care (6).HRS is a late complication of cirrhosis that accounted for 3.2% of all hospital discharges related to cirrhosis according to a 2012 study based on a large inpatient health care database of patients representative of community hospitals in the United States (4). Moreover, the number of HRS discharges in the United States has increased significantly in the past 2 decades (7). HRS was also associated with high inpatient mortality (~46%), as well as longer lengths of stay and higher costs of hospitalizations, compared to cirrhosis discharges without HRS.

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Portal hypertension and surgery on the patient with cirrhosis

Fink

2019

Textbook of Surgery

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Safety and effectiveness of umbilical hernia repair in patients with cirrhosis

Cited by 22 publications

References 18 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

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

Portal hypertension and surgery on the patient with cirrhosis

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