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ORIGINAL ARTICLE
Year : 2017  |  Volume : 36  |  Issue : 4  |  Page : 372-379

Repair of uncomplicated umbilical hernia in cirrhotic patients: experience of an institute


Department of Surgery, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt

Correspondence Address:
Ashrf El-Kholy A Othman
Department of Surgery, National Hepatology and Tropical Medicine Research Institute, Cairo, 13111
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejs.ejs_52_17

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Objective The objective of this study was to present experience of a single institute in the management of uncomplicated umbilical hernia (UH) in cirrhotic patients. Patients and methods The study included 232 patients with UH: 103 patients class A, 83 Child–Pugh class B, and 46 Child–Pugh class C. Ascites was mild in 46 patients, moderate in 80 patients, and severe in seven patients, whereas 99 patients had no ascites. All patients underwent classic repair with proline mesh insertion if required. Results A total of 71 patients had direct defect closure and 161 patients had mesh repair. Operative time was significantly longer in class C patients than other classes and in patients of class B than class A. Peritoneal drainage was required in 109 patients with significantly higher frequency in class C. ICU admission was required in 33 patients with significantly higher frequency and longer duration in patients of class C. Duration of subcutaneous wound drainage was significantly longer, frequency of patients who developed short-term postoperative complications was significantly higher and hospital length of stay was significantly longer for patients of class C. During the follow-up for 23.2±7.9 months, 23 patients developed recurrent UH with significantly higher frequency in class C than other classes. Recurrence rate was significantly lower with mesh repair than direct closure (6.8 vs. 16.9%). During follow-up, 14 (6%) patients died secondary to causes not related to surgery with significantly higher in class C. Conclusion Elective UH repair in cirrhotic patients is feasible and is associated with acceptable rate of postoperative complications and no surgery-related mortalities. Mesh repair significantly reduced the recurrence rate. The pronounced outcome of patients of class A points to the necessity of early repair of UH to get the benefit of hepatic reserve and minimal volume of ascetic fluid.


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