Management of umbilical hernia complicated with liver cirrhosis: an advocate of early and elective herniorrhaphy.

Choi, Sae Byeol; Hong, Kwang Dae; Lee, Jin Suk; Han, Hyung Joon; Kim, Wan Bae; Song, Tae Jin; Suh, Sung Ock; Kim, Young Chul; Choi, Sang Yong

BACKGROUND Patients with umbilical hernias complicated by liver cirrhosis have an increased likelihood of complications following herniorrhaphy. The aim of this study was to investigate the clinical outcomes in patients with umbilical hernias complicated by liver cirrhosis. METHODS Between 2001 and 2010, 44 patients were enrolled in this study. The comparison between non-operative and operative group was performed. Patients who underwent emergency versus elective surgery were also compared. RESULTS Of the 44 patients, there were 33 men and 11 women. Thirty-one patients (70.5%) underwent surgery and 13 patients (29.5%) were treated conservatively. Overall morbidity and mortality rates following herniorrhaphy were 42% and 6.5%. The mean albumin level was significantly lower and total bilirubin, creatinine and mean model of end-stage liver disease score were significantly higher in non-operative group than in operative group. Combined resection was performed more frequently in the emergency group than in elective group. A significantly higher proportion of patients in emergency operation group had postoperative complications (P=0.01), especially ascites (P=0.02). The operative time and postoperative hospital stay were significantly shorter in the elective operation group than in emergency operation group. CONCLUSIONS Early, elective repair of umbilical hernias in cirrhotic patients should be advocated considering the hepatic reserve and patient's condition. Ascites control is the mainstay of post-operative management.