Umbilical Hernia Repair in Cirrhotic Patients With Ascites: A Systemic Review of Literature

Guo, Chenchen; Liu, Quanguo; Wang, Yong; Li, Junsheng

doi:10.1097/sle.0000000000000891

Cited by 11 publications

(11 citation statements)

References 51 publications

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“…Our data is consistent with literature demonstrating that emergency repair confers a high risk of peri-operative morbidity. 1,[3][4][5][6][7] In those that underwent immediate or delayed surgery, mortality was substantially lower than the non-surgically managed group (25 vs 73%). Multivariable analysis re-demonstrated that those who underwent surgery had lower risk of mortality despite…”

Section: Discussionmentioning

confidence: 94%

Leaking Umbilical Hernias in Cirrhotic Patients, Repair or Observe?

Torabi

Florman

Divino

2022

The American Surgeon™

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Background Umbilical hernias (UHs) in cirrhotic patients are common, can be quite complicated and are associated with significant morbidity and mortality. Leakage of ascites is a challenging entity and poses significant risks. Methods This is a retrospective study of patients with cirrhosis and UHs with ascitic leakage. Patients were divided into two groups: patients managed operatively during index admission (Group 1) and those managed non-surgically during index admission (Group 2). Group 2 was further divided into those that subsequently underwent repair of UH and those managed medically. Results Of 47 cirrhotic patients with leaking UHs, 19 patients were managed surgically during index admission (Group 1). In Group 2, 15 patients were managed non-surgically and 13 subsequently underwent surgery. The groups had comparable demographics, MELD-Na and Child-Pugh class. Group 2 had a higher rate of emergency surgery (92% vs 58%, P = .04) and higher rate of recurrence (31 vs. 0%, P = .02). The non-surgical patients in Group 2 had higher 1-year mortality (67%) compared to Group 1 (21%) and surgical patients in Group 2 (31%, P = .007). Multi-variable logistic regression for 1-year mortality demonstrated MELD-Na as the most significant risk factor (OR = 1.2, P = .05) and undergoing UH repair as the most significant protective factor (OR = .16, P = .02). Conclusions Cirrhotic patients with leaking UHs should undergo urgent repair. Non-operative management confers high risk of continued or increased ascitic leakage necessitating more emergent surgery. Despite high rate of post-operative complications related to cirrhosis, there is a clear mortality benefit to the repair of leaking UHs in cirrhotic patients.

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Section: Discussionmentioning

confidence: 94%

Leaking Umbilical Hernias in Cirrhotic Patients, Repair or Observe?

Torabi

Florman

Divino

2022

The American Surgeon™

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“…Recent advances in the clinical care of liver cirrhosis and improved surgical techniques have provided satisfactory outcomes in well-selected and optimised group of patients in procedures such as umbilical hernia repair [28] and laparoscopic cholecystectomy [29]. However, for colorectal pathologies that require major resection, a considerable peri-operative risk with a median overall complication rate of 47.1% still challenges the surgeon in offering the best treatment options.…”

Section: Discussionmentioning

confidence: 99%

“…Operative procedures in patients with liver cirrhosis are often associated with high incidence of morbidity due to bleeding risk from coagulopathy and complications associated with liver decompensation such as infective ascitic fluid, wound dehiscence/infection and multiorgan failure. Recent advances in the clinical care of liver cirrhosis and improved surgical techniques have provided satisfactory outcomes in well‐selected and optimised group of patients in procedures such as umbilical hernia repair [28] and laparoscopic cholecystectomy [29]. However, for colorectal pathologies that require major resection, a considerable peri‐operative risk with a median overall complication rate of 47.1% still challenges the surgeon in offering the best treatment options.…”

Section: Discussionmentioning

confidence: 99%

Colorectal Surgery in Patients with Liver Cirrhosis: A Systematic Review

Tan

Theophilus

2023

World j. surg.

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Background Colorectal surgery in patients with liver cirrhosis poses a significant challenge due to the associated peri-operative morbidity and mortality risks. The aim of this systematic review was to evaluate the outcomes in this cohort of patients following colorectal surgery. Methods The PubMed, Embase and Cochrane databases and references were searched up to October 2022 using the PRISMA guidelines. The data collated included: patient demographics, pathology or type of colorectal operation performed, severity of liver cirrhosis, post-operative complication rates, mortality rates and prognostic factors. A quality assessment of included studies was performed with the Newcastle-Ottawa scale.Results Sixteen studies reporting the outcomes of colorectal surgery in patients with liver cirrhosis were identified, including the results of 8646 patients. The indications, pathologies and/or type of operations varied. The overall complication rate ranged from 29 to 75%, minor complication ranged 14.5-37% and major complication ranged 6.7-59.3%. The mortality rates ranged from 0 to 37%. Conclusion Colorectal surgery in patients with liver cirrhosis still carries considerable morbidity and mortality rates. This group of patients needs to be managed in a multidisciplinary setting to achieve excellent outcomes. Future research should focus on uniform definitions to enable interpretable outcomes.

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“…Prior studies found that emergent repair of hernia is associated with increased morbidity, mortality, and HLOS [ 3 , 12 , 16 , 29 , 30 , 31 ]. This highlights the need for early intervention and surveillance to prevent such complications requiring emergency surgery [ 26 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients

Patel

Smiley

Feingold

et al. 2022

IJERPH

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The goal of this study was to identify risk factors that are associated with mortality in adult and elderly patients who were hospitalized for umbilical hernia. A total of 14,752 adult patients (ages 18–64 years) and 6490 elderly patients (ages 65+), who were admitted emergently for umbilical hernia, were included in this retrospective cohort study. The data were gathered from the National Inpatient Sample (NIS) 2005–2014 database. Predictors of mortality were identified via a multivariable logistic regression, in patients who underwent surgery and those who did not for adult and elderly age groups. The mean (SD) ages for adult males and females were 48.95 (9.61) and 46.59 (11.35) years, respectively. The mean (SD) ages for elderly males and females were 73.62 (6.83) and 77.31 (7.98) years, respectively. The overall mortality was low (113 or 0.8%) in the adult group and in the elderly group (179 or 2.8%). In adult patients who underwent operation, age (OR = 1.066, 95% CI: 1.040–1.093, p < 0.001) and gangrene (OR = 5.635, 95% CI: 2.288–13.874, p < 0.001) were the main risk factors associated with mortality. Within the same population, female sex was found to be a protective factor (OR = 0.547, 95% CI: 0.351–0.854, p = 0.008). Of the total adult sample, 43% used private insurance, while only 18% of patients in the deceased population used private insurance. Conversely, within the entire adult population, only about 48% of patients used Medicare, Medicaid, or self-pay, while these patients made up 75% of the deceased group. In the elderly surgical group, the main risk factors significantly associated with mortality were frailty (OR = 1.284, 95% CI: 1.105–1.491, p = 0.001), gangrene (OR = 13.914, 95% CI: 5.074–38.154, p < 0.001), and age (OR = 1.034, 95% CI: 1.011–1.057, p = 0.003). In the adult non-operation group, hospital length of stay (HLOS) was a significant risk factor associated with mortality (OR = 1.077, 95% CI: 1.004–1.155, p = 0.038). In the elderly non-operation group, obstruction was the main risk factor (OR = 4.534, 95% CI: 1.387–14.819, p = 0.012). Elderly patients experienced a 3.5-fold higher mortality than adult patients who were emergently admitted with umbilical hernia. Increasing age was a significant risk factor of mortality within all patient populations. In the adult surgical group, gangrene, Medicare, Medicaid, and self-pay were significant risk factors of mortality and female sex was a significant protective factor. In the adult non-surgical group, HLOS was the main risk factor of mortality. In the elderly population, frailty and gangrene were the main risk factors of mortality within the surgical group, and obstruction was the main risk factor for the non-surgical group.

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Umbilical Hernia Repair in Cirrhotic Patients With Ascites: A Systemic Review of Literature

Cited by 11 publications

References 51 publications

Leaking Umbilical Hernias in Cirrhotic Patients, Repair or Observe?

Leaking Umbilical Hernias in Cirrhotic Patients, Repair or Observe?

Colorectal Surgery in Patients with Liver Cirrhosis: A Systematic Review

Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients

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