A prospective study on elective umbilical hernia repair in patients with liver cirrhosis and ascites

Surgery. 2011 Sep;150(3):542-6. doi: 10.1016/j.surg.2011.02.026. Epub 2011 May 31.


Background: Patients with both cirrhosis and ascites have a 20% risk of developing umbilical hernia. A retrospective study from our center comparing conservative management of umbilical hernia with elective repair in these patients showed a significant risk of mortality as a result of hernia incarceration in conservatively treated patients. The goal of this study was to assess the safety and efficacy of elective umbilical hernia repair in these patients prospectively.

Methods: Patients with liver cirrhosis and ascites presenting with an umbilical hernia were included in this study. For all patients, the expected time to liver transplantation was more than 3 months, and they did not have a patent umbilical vein in the hernia sac. The following data were collected prospectively for all patients: Child-Pugh-Turcotte (CPT) classification, model for end-stage liver disease (MELD) score, kidney failure, cardiovascular comorbidity, operation-related complications, and duration of hospital stay. Mortality rates were registered in hospital records and verified in government records during follow-up. Mortality rates were registered in hospital records and verified in government records during follow-up. On completion of the study, a retrospective survey was performed to search for any patients who met the study inclusion criteria but were left out of the study cohort.

Results: In total, 30 patients (25 males) underwent operation at a mean age of 58 years (standard deviation [SD] ± 9 years). Of these 30 patients, 6 were classified as CPT grade A (20%), 19 (63%) as grade B, and 5 (17%) as grade C. The patients' median MELD score was 12 (interquartile range [IQR], 8-16). In 10 (33%) of the 30 patients hernia repair was performed with mesh. The median duration of hospital stay was 3 days (IQR, 2-4). None of the patients were admitted to the intensive care unit. Postoperative complications included pneumonia and decompensation of cirrhosis (1 case each,) resulting in prolonged hospital stay for those 2 patients. After a median follow-up period of 25 months (IQR, 14-34), 2 (7%) of the 30 patients died; neither of the deaths were attributable to the umbilical hernia repair. A total of 2 patients suffered recurrence.

Conclusion: Elective umbilical hernia repair is safe and the preferred approach in cirrhotic patients with ascites.

MeSH terms

  • Aged
  • Ascites / complications*
  • Ascites / diagnosis
  • Cohort Studies
  • Elective Surgical Procedures / adverse effects
  • Elective Surgical Procedures / methods*
  • Follow-Up Studies
  • Hernia, Umbilical / etiology*
  • Hernia, Umbilical / surgery*
  • Humans
  • Laparotomy / adverse effects
  • Laparotomy / methods
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diagnosis
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / physiopathology
  • Prospective Studies
  • Risk Assessment
  • Safety Management
  • Severity of Illness Index
  • Treatment Outcome