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01-06-2020 | Hepatic Encephalopathy | Original Article

Prognosis of surgical hernia repair in cirrhotic patients with refractory ascites

Authors: S. W. Kim, M. A. Kim, Y. Chang, H. Y. Lee, J. S. Yoon, Y. B. Lee, E. J. Cho, J.-H. Lee, S. J. Yu, J.-H. Yoon, K. J. Park, Y. J. Kim

Published in: Hernia | Issue 3/2020

Abstract

Background

Abdominal wall hernias are common in patients with ascites. Elective surgical repair is recommended for the treatment of abdominal wall hernias. However, surgical hernia repair in cirrhotic patients with refractory ascites is controversial. In this study, we aimed to evaluate the outcomes of elective surgical hernia repair in patients with liver cirrhosis with and without refractory ascites.

Method

From January 2005 to June 2018, we retrospectively reviewed the records of consecutive patients with liver cirrhosis who underwent a surgical hernia repair.

Results

This study included 107 patients; 31 patients (29.0%) had refractory ascites. Preoperatively, cirrhotic patients with refractory ascites had a higher median model for end-stage liver disease (MELD) score (13.0 vs 11.0, P = 0.001) than those without refractory ascites. The 30-day mortality rate (3.2% vs 0%, P = 0.64) and the risk of recurrence (hazard ratio 0.410; 95% CI 0.050–3.220; P = 0.39) did not differ significantly between cirrhotic patients with refractory ascites and cirrhotic patients without refractory ascites. Among cirrhotic patients with refractory ascites, albumin (P = 0.23), bilirubin (P = 0.37), creatinine (P = 0.97), and sodium levels (P = 0.35) did not change significantly after surgery.

Conclusion

In advanced liver cirrhosis patients with refractory ascites, hernias can be safely treated with elective surgical repair. Mortality rate within 30 days did not differ by the presence or absence of refractory ascites. Elective hernia repair might be beneficial for treatment of abdominal wall hernia in cirrhotic patients with refractory ascites.

Andraus W, Pinheiro RS, Lai Q, Haddad LBP, Nacif LS, D'Albuquerque LAC, Lerut J (2015) Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality. BMC Surg 15:65. https://doi.org/10.1186/s12893-015-0052-y CrossRefPubMedPubMedCentral

Wang R, Qi X, Peng Y, Deng H, Li J, Ning Z, Dai J, Hou F, Zhao J, Guo X (2016) Association of umbilical hernia with volume of ascites in liver cirrhosis: a retrospective observational study. J Evid Based Med 9(4):170–180. https://doi.org/10.1111/jebm.12225 CrossRefPubMed

Teh SH, Nagorney DM, Stevens SR, Offord KP, Therneau TM, Plevak DJ, Talwalkar JA, Kim WR, Kamath PS (2007) Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology 132(4):1261–1269. https://doi.org/10.1053/j.gastro.2007.01.040 CrossRefPubMed

Salamone G, Licari L, Guercio G, Campanella S, Falco N, Scerrino G, Bonventre S, Geraci G, Cocorullo G, Gulotta G (2018) The abdominal wall hernia in cirrhotic patients: a historical challenge. World J Emerg Surg 13:35. https://doi.org/10.1186/s13017-018-0196-z CrossRefPubMedPubMedCentral

Marsman HA, Heisterkamp J, Halm JA, Tilanus HW, Metselaar HJ, Kazemier G (2007) Management in patients with liver cirrhosis and an umbilical hernia. Surgery 142(3):372–375. https://doi.org/10.1016/j.surg.2007.05.006 CrossRefPubMed

McKay A, Dixon E, Bathe O, Sutherland F (2009) Umbilical hernia repair in the presence of cirrhosis and ascites: results of a survey and review of the literature. Hernia 13(5):461–468. https://doi.org/10.1007/s10029-009-0535-9 CrossRefPubMed

Coelho JC, Claus CM, Campos AC, Costa MA, Blum C (2016) Umbilical hernia in patients with liver cirrhosis: a surgical challenge. World J Gastrointest Surg 8(7):476–482. https://doi.org/10.4240/wjgs.v8.i7.476 CrossRefPubMedPubMedCentral

KASL (2018) KASL clinical practice guidelines for liver cirrhosis: ascites and related complications. Clin Mol Hepatol 24(3):230–277. https://doi.org/10.3350/cmh.2018.1005 CrossRef

Caly WR, Abreu RM, Bitelman B, Carrilho FJ, Ono SK (2017) Clinical features of refractory ascites in outpatients. Clinics (Sao Paulo, Brazil) 72(7):405–410. https://doi.org/10.6061/clinics/2017(07)03 CrossRef

10.

Carbonell AM, Wolfe LG, DeMaria EJ (2005) Poor outcomes in cirrhosis-associated hernia repair: a nationwide cohort study of 32,033 patients. Hernia 9(4):353–357. https://doi.org/10.1007/s10029-005-0022-x CrossRefPubMed

11.

Yu BC, Chung M, Lee G (2015) The repair of umbilical hernia in cirrhotic patients: 18 consecutive case series in a single institute. Ann Surg Treat Res 89(2):87–91. https://doi.org/10.4174/astr.2015.89.2.87 CrossRefPubMedPubMedCentral

12.

Eker HH, van Ramshorst GH, de Goede B, Tilanus HW, Metselaar HJ, de Man RA, Lange JF, Kazemier G (2011) A prospective study on elective umbilical hernia repair in patients with liver cirrhosis and ascites. Surgery 150(3):542–546. https://doi.org/10.1016/j.surg.2011.02.026 CrossRefPubMed

13.

European Association for the Study of the Liver (2018) EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 69(2):406–460. https://doi.org/10.1016/j.jhep.2018.03.024 CrossRef

14.

Oh HK, Kim H, Ryoo S, Choe EK, Park KJ (2011) Inguinal hernia repair in patients with cirrhosis is not associated with increased risk of complications and recurrence. World J Surg 35(6):1229–1233. https://doi.org/10.1007/s00268-011-1007-9 (discussion 1234) CrossRefPubMed

15.

Park JK, Lee SH, Yoon WJ, Lee JK, Park SC, Park BJ, Jung YJ, Kim BG, Yoon JH, Kim CY, Ha J, Park KJ, Kim YJ (2007) Evaluation of hernia repair operation in Child-Turcotte-Pugh class C cirrhosis and refractory ascites. J Gastroenterol Hepatol 22(3):377–382. https://doi.org/10.1111/j.1440-1746.2006.04458.x CrossRefPubMed

16.

Hew S, Yu W, Robson S, Starkey G, Testro A, Fink M, Angus P, Gow P (2018) Safety and effectiveness of umbilical hernia repair in patients with cirrhosis. Hernia 22(5):759–765. https://doi.org/10.1007/s10029-018-1761-9 CrossRefPubMed

17.

Friedman LS (2010) Surgery in the patient with liver disease. Trans Am Clin Climatol Assoc 121:192–205PubMedPubMedCentral

18.

Csikesz NG, Nguyen LN, Tseng JF, Shah SA (2009) Nationwide volume and mortality after elective surgery in cirrhotic patients. J Am Coll Surg 208(1):96–103. https://doi.org/10.1016/j.jamcollsurg.2008.09.006 CrossRefPubMed

19.

Cho HC, Jung HY, Sinn DH, Choi MS, Koh KC, Paik SW, Yoo BC, Kim SW, Lee JH (2011) Mortality after surgery in patients with liver cirrhosis: comparison of Child–Turcotte–Pugh MELD and MELDNa score. Eur J Gastroenterol Hepatol 23(1):51–59. https://doi.org/10.1097/MEG.0b013e3283407158 CrossRefPubMed

20.

Adebayo D, Neong SF, Wong F (2018) Refractory ascites in liver cirrhosis. Am J Gastroenterol. https://doi.org/10.1038/s41395-018-0185-6 CrossRef

Title: Prognosis of surgical hernia repair in cirrhotic patients with refractory ascites
Authors: S. W. Kim
M. A. Kim
Y. Chang
H. Y. Lee
J. S. Yoon
Y. B. Lee
E. J. Cho
J.-H. Lee
S. J. Yu
J.-H. Yoon
K. J. Park
Y. J. Kim
Publication date: 01-06-2020
Publisher: Springer Paris
Keywords: Hepatic Encephalopathy
Liver Cirrhosis
Ascites
Hepatic Encephalopathy
Published in: Hernia / Issue 3/2020
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-019-02043-2

At a glance: The STEP trials

Springer Medicine

Prognosis of surgical hernia repair in cirrhotic patients with refractory ascites

Abstract

Background

Method

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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