Surgical repair of umbilical hernia in cirrhotic patients with ascites: is it safe?

Background Umbilical herniorrhaphy in cirrhotic patients with ascites is not usually done due to high postoperative morbidity and mortality rates. However, recent reports recommending elective surgery in these patients with perioperative preparation will result in good and safe outcome to avoid emergent repair later on. The aim of this study was to evaluate the outcome of umbilical herniorrhaphy in patients with liver cirrhosis and ascites regarding postoperative morbidity and mortality. Patients and methods A retrospective study was done on 102 patients with umbilical hernia and ascites in the period between March 2014 and April 2017 who had undergone surgical repair either electively or emergently at Tanta University Hospital. Patient characteristics, morbidity, and mortality are recorded. Results Seventy-two men and 30 women with a mean age of 51.3 years were analyzed. Eighteen (17.6%) patients were of Child-Pugh-Turcotte (CPT) class A, 54 (53%) patients were of class B, and 30 (29.4%) patients were of class C. The patients had a model for end-stage liver disease score of 16.23. Fifty-seven patients underwent elective operations while 45 patients underwent emergency surgery of whom 24 patients had incarceration, 12 cases had rupture of the hernia sac, and nine cases had skin ulceration or necrosis. Primary repair was done in 60 (58.8%) patients and meshes were used in 42 (41.2%) patients. The morbidity and mortality rates were 37.2% (n=38) and 3.9% (n=4), respectively. Conclusion Elective repair of umbilical hernia can be performed easily and safely in cirrhotic patients with ascites with good perioperative preparation with better results than emergent repair.