Hernia Management in Cirrhosis: Risk Assessment, Operative Approach, and Perioperative Care

Myers, Sara P.; Kulkarni, Shreyus S.; Malik, Shahid M.; Tevar, Amit D.; Neal, Matthew D.

doi:10.1016/j.jss.2018.09.052

Cited by 4 publications

(8 citation statements)

References 50 publications

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“…DiscussionThis article describes a consecutive cohort of patients with ESLD who underwent repair of symptomatic umbilical hernias at a single institution; with mortality rates that are comparable with existing studies[2,6,8,9,[16][17][18].…”

supporting

confidence: 60%

“…This article describes a consecutive cohort of patients with ESLD who underwent repair of symptomatic umbilical hernias at a single institution; with mortality rates that are comparable with existing studies [2,6,8,9,16–18]. Emergency surgery was associated with increased postoperative morbidity and length of hospital stay but did not predict mortality.…”

Section: Discussionmentioning

confidence: 60%

“…In this study, 72.2% of patients presented as an emergency requiring urgent surgery, and only 25.6% were eligible for liver transplantation. In previous studies, the emergency repair was associated with a significant increase in morbidity and mortality compared with elective repair in patients with ESLD [3,4,9,16,17,22,23]. In this series, the emergency repair was associated with increased postoperative morbidity including wound-related problems, decompensation, need for ICU admission as well as increased LOS.…”

Section: Differences Pre-and Post-2014mentioning

confidence: 58%

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Risk factors for decompensation and death following umbilical hernia repair in patients with end-stage liver disease

Malik

Varghese

Pandanaboyana

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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Introduction Symptomatic umbilical hernias are a common cause of morbidity and mortality in patients with cirrhosis and end-stage liver disease (ESLD). This study set out to characterise the factors predicting outcome following repair of symptomatic umbilical hernias in ESLD at a single institution. Methods A retrospective review was performed of all patients with ESLD who underwent repair of a symptomatic umbilical hernia between 1998 and 2020. Overall survival was predicted using the Kaplan–Meier method. Logistic regression was used to determine predictors of decompensation and 30-day, 90-day and 1-year mortality. Results One-hundred-and-eight patients with ESLD underwent umbilical hernia repair (emergency n = 78, 72.2%). Transjugular shunting was performed in 29 patients (26.9%). Decompensation occurred in 44 patients (40.7%) and was predicted by emergency surgery (OR, 13.29; P = 0.001). Length of stay was shorter in elective patients compared to emergency patients (3-days vs. 7-days; P = 0.003). Thirty-day, 90-day and 1-year survival was 95.2, 93.2 and 85.4%, respectively. Model for ESLD score >15 predicted 90-day mortality (OR, 18.48; P = 0.030) and hyponatraemia predicted 1-year mortality (OR, 5.31; P = 0.047). Transjugular shunting predicted survival at 1 year (OR, 0.15; P = 0.038). Conclusions Repair of symptomatic umbilical hernias in patients with ESLD can be undertaken with acceptable outcomes in a specialist centre, however, this remains a high-risk intervention. Patients undergoing emergency repair are more likely to decompensate postoperatively, develop wound-related problems and have a longer length of stay. Transjugular shunting may confer a benefit to survival, but further prospective trials are warranted.

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supporting

confidence: 60%

Section: Discussionmentioning

confidence: 60%

Section: Differences Pre-and Post-2014mentioning

confidence: 58%

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Risk factors for decompensation and death following umbilical hernia repair in patients with end-stage liver disease

Malik

Varghese

Pandanaboyana

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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“…Patients with cirrhosis have a high incidence of abdominal wall hernias, and following surgical correction, have a higher morbimortality. The ideal surgical strategy, as well as time to correct abdominal hernias is controversial 14,16 . The advantage of having this knowledge would be to predict which patients are at elevated risk of developing postoperative AKI.…”

Section: Discussionmentioning

confidence: 99%

“…A cohort study by Andraus et al 1 evaluated 67 patients with cirrhosis submitted to hernial correction. The median MELD score was 14 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Emergency surgery was carried out in 34 patients due to hernial rupture (n=13), incarceration (n=10), strangulation (n=4) and skin necrosis or ulceration (n=7).…”

Section: Discussionmentioning

confidence: 99%

Cirrhotic Patients With Acute Kidney Injury (Aki) Have Higher Mortality After Abdominal Hernia Surgery

Ducatti

Haddad

Meyer

et al. 2021

ABCD, arq. bras. cir. dig.

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Background: The incidence of abdominal hernia in cirrhotic patients is as higher as 20%; in cases of major ascites the incidence may increase up to 40%. One of the main and most serious complications in cirrhotic postoperative period (PO) is acute kidney injury (AKI). Aim: To analyze the renal function of cirrhotic patients undergoing to hernia surgery and evaluate the factors related to AKI. Methods: Follow-up of 174 cirrhotic patients who underwent hernia surgery. Laboratory tests including the renal function were collected in the PO.AKI was defined based on the consensus of the ascite´s club. They were divided into two groups: with (AKI PO) and without AKI . Results: All 174 patients were enrolled and AKI occurred in 58 (34.9%). In the AKI PO group, 74.1% had emergency surgery, whereas in the group without AKI PO it was only 34.6%.In the group with AKI PO, 90.4% presented complications, whereas in the group without AKI PO they occurred only in 29.9%. Variables age, baseline MELD, baseline creatinine, creatinine in immediate postoperative (POI), AKI and the presence of ascites were statistically significant for survival. Conclusions: There is association between AKI PO and emergency surgery and, also, between AKI PO and complications after surgery. The factors related to higher occurrence were initial MELD, basal Cr, Cr POI. The patients with postoperative AKI had a higher rate of complications and higher mortality.

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Die Bedeutung von Komorbiditäten bei der Planung von Hernienoperationen

Verdaguer-Tremolosa,

Rodrigues-Gonçalves,

López-Cano

2024

Roboterassistierte Hernienchirurgie

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Hernia Management in Cirrhosis: Risk Assessment, Operative Approach, and Perioperative Care

Cited by 4 publications

References 50 publications

Risk factors for decompensation and death following umbilical hernia repair in patients with end-stage liver disease

Risk factors for decompensation and death following umbilical hernia repair in patients with end-stage liver disease

Cirrhotic Patients With Acute Kidney Injury (Aki) Have Higher Mortality After Abdominal Hernia Surgery

Die Bedeutung von Komorbiditäten bei der Planung von Hernienoperationen

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