Short-Term Outcomes of Umbilical Hernia Repair with Cirrhosis and Ascites

Abstract

Background: Umbilical hernia is a popular disease, especially in patients with cirrhosis and ascites. The high and prolonged intra-abdominal fluid leads to increased intra-abdominal pressure, which causes the hernia to grow rapidly and cause complications. The clinical manifestations are mainly two: signs of hernia and symptoms of cirrhosis and ascites. The diagnosis of this condition is relatively simple, based mainly on clinical findings, and sometimes supported by imaging techniques. Umbilical hernia management in patients with cirrhosis and ascites has shifted towards early surgical repair to avoid complications. Two techniques of hernia reconstruction are available: simple suture and mesh implantation. Mesh-based methods are regarded as superior, but surgery in this population has many potential hazards and is still a surgical dilemma. This study examines the short-term outcomes of umbilical hernia reconstruction in patients with cirrhosis and ascites. Subjects – Methods: We conducted a retrospective study on 43 patients with cirrhosis and ascites who had umbilical hernia repair surgery at Cho Ray Hospital from January 2018 to December 2022. The surgery was either elective or emergency. We recorded the patient characteristics, surgical approaches, morbidity, and mortality. We followed up the patients for 30 days after the surgery. Results: The male: female ratio was 4:1. The average of age was 56.8 ± 10.7 years old (range: 27 – 79 years old). BMI was categorized into four groups: underweight in 9/43 cases (9.3%), normal in 22/43 cases (51.2%), overweight in 8/43 cases (18.6%), and obese in 9/43 cases (20.9%). All patients had a protrusion in the umbilicus when they were admitted to the hospital. Hernia pain and tenderness were present in 51.2% and 55.8% of the cases, respectively. 8/43 cases (18.6%) had complications of hernia rupture. The mean size of the hernia was 6.4 ± 5.1 cm (range: 2 – 30 cm). The patients underwent emergency surgery in 37/43 cases (86%). All surgeries were open, and the methods of hernia repair were simple suture in 35/43 cases (81.4%), onlay mesh placement in 4/43 cases (9.3%), sublay mesh placement in 1/43 case (2.3%), and preperitoneal mesh placement in 3/43 cases (7%). The mean operative time was 93 ± 37.2 minutes (range: 50-200 minutes). The mean hospital stay was 7 ± 3.2 days (range: 2 – 17 days). There were 13 cases with postoperative complications, accounting for 30%. 2 deaths occurred due to intra-abdominal bleeding and severe peritonitis. Conclusion: Umbilical hernia is a frequent complication in patients with ascites and cirrhosis. The diagnosis is mainly based on clinical signs, and imaging techniques are used in complicated cases that require further evaluation of the content and condition of the hernia sac. The patients have a high rate of complications and mortality after surgery, which are related to late surgery, degree of cirrhosis, and MELD score ≥ 20. Therefore, the patients need early diagnosis and surgery to avoid complications that affect their survival.