Umbilical hernia in cirrhotic patients: conservative treatment or surgery?

Abstract

Background: Ascites is a common complication in patients with cirrhosis, and elevated
intraabdominal pressure can lead to the development of abdominal wall hernias, particularly in patients with latent umbilical defects.
Objectives: The aim of this study was to report the incidence and benefits of elective surgery for the management of umbilical hernias in cirrhotic patients with ascites.
Material and methods: Between January 2015 and January 2019 15 patients with symptomatic umbi- lical hernia underwent elective surgery in a public hospital; 100% were men with a history of alcoho- lism and were hospitalized due to liver cirrhosis. The defect was closed, and a polypropylene mesh was placed in the supra-aponeurotic plane in most cases.
Results: The preoperative risk was estimated using the Child-Pugh score. Ascites was evacuated in all the cases. Patients were followed-up every 30 days during the first 6 months and then twice a year.
There were no hernia recurrences. Two patients were lost to follow-up 12 months after surgery and 1 patient died 9 months after the procedure due to progression of cirrhosis.
Conclusions: Patients with liver cirrhosis and umbilical hernia should undergo elective surgery. Watchful waiting is associated with higher risk of hernia rupture and high morbidity and mortality