Patient Optimization is the Key in Surgical Repair of Ruptured Umblical Hernia in Cirrhotic Patients and Tense Ascitis

Abstract

Background: Ulceration, leakage, and rupture are considered as the most common complications of umbilical hernias in patients with refractory ascites due to advanced cirrhosis. We aim to determine optimal management and outcome after umbilical herniorrhaphy or hernioplasty in those patients. Methods:A retrospective chart review was performed on 37 patients with advanced cirrhosis who underwent umbilical herniorrhaphy or hernioplasty at our hospital.Results: A total of 37 patients (12 female, 32.4%) had refractory ascites, with mean age of 52.2 ± 7.7 years (ranging from 37 to 70 years), 30 presented with leaking luid, 5 with ulceration, and only 2 with spontaneous umbilical rupture. A total of 33 (89.2%) required perioperative human albumin transfusion, and only 7 (18.9%) required perioperative paracentesis. Only ive patients (13.5%) required preoperative platelets transfusion.Propylene mesh was used in seven (18.9%) cases. Eleven patients (29.7%) developed ascites-related wound complications. Leaking ascites was recorded in three cases (8.1%) and only one case (2.7%) developed wound dehiscence and required reoperation. Hematemesis and melena were recorded in three (8.1%) early post operative without renal deterioration or encephalopathy. No early postoperative mortality. Conclusion:With meticulous preoperative patient optimization, management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible.