The authors declare that they have no competing interests.
WA, have made substantial contributions to conception and design, acquisition and interpretation of data; have been involved in drafting and revising the manuscript. RP, have made substantial contributions to acquisition, analysis and interpretation of data; have been involved in drafting and revising the manuscript. QL, have made substantial contributions to design, analysis and interpretation of data; have been involved in and revising the manuscript. LH, have made substantial contributions to analysis and interpretation of data. LN, have made substantial contributions to acquisition, interpretation of data; have been involved in drafting the manuscript. LA, have been involved in revising critically for important intellectual content. JL, have been involved in revising the manuscript critically for important intellectual content, and have given final approval of the version to be published. All authors read and approved the final manuscript.
Patients with cirrhosis have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical management strategy as well as timing of abdominal hernia repair remains controversial.
A cohort study of 67 cirrhotic patients who underwent hernia repair during the period of January 1998-December 2009 at the University Hospital of Sao Paulo were included. After meeting study criteria, a total of 56 patients who underwent 61 surgeries were included in the final analysis. Patient characteristics, morbidity (Clavien score), mortality, Child-Turcotte-Pugh score, MELD score, use of prosthetic material, and elective or emergency surgery have been analysed with regards to morbidity and 30-day mortality.
The median MELD score of the patient population was 14 (range: 6 to 24). Emergency surgery was performed in 34 patients because of ruptured hernia (n = 13), incarceration (n = 10), strangulation (n = 4), and skin necrosis or ulceration (n = 7). Elective surgery was performed in 27 cases. After a multivariable analysis, emergency surgery (OR 7.31; p 0.017) and Child-Pugh C (OR 4.54; p 0.037) were risk factors for major complications. Moreover, emergency surgery was a unique independent risk factor for 30-day mortality (OR 10.83; p 0.028).
Higher morbidity and mortality are associated with emergency surgery in advanced cirrhotic patients. Therefore, using cirrhosis as a contraindication for hernia repair in all patients may be reconsidered in the future, especially after controlling ascites and in those patients with hernias that are becoming symptomatic or show signs of possible skin necrosis and rupture. Future prospective randomized studies are needed to confirm this surgical strategy.
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Befeler AS, Palmer DE, Hoffman M, Longo W, Solomon H, Di Bisceglie AM. The safety of intra-abdominal surgery in patients with cirrhosis: Model for end-stage liver disease score is superior to child-turcotte-pugh classification in predicting outcome. Arch Surg. 2005;140:650–4. discussion 655. CrossRefPubMed
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- Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality
Rafael Soares Pinheiro
Luciana B.P Haddad
Lucas S Nacif
Luiz Augusto C D’Albuquerque
- BioMed Central
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