title: Umbilical hernia repair in cirrhotic patients: utility of temporary peritoneal dialysis catheter.
abstract: Umbilical herniorrhaphy in cirrhotic patients with ascites is associated with a significant morbidity, recurrence rate, and mortality and therefore is often managed expectantly. Operative repair is indicated if an ascites leak or infection develops. Surgeons must consider the management of postoperative ascites to reduce recurrence rates and complications. We present a unique method using temporary peritoneal dialysis catheter placement (PD). Eight patients with moderate to massive ascites underwent umbilical herniorrhaphy with concomitant peritoneal dialysis placement. Patients have been followed for 8 to 30 months. All patients had successful repair of their hernia with 1 recurrence at 6 months and 1 late death (14 months). Patients were able to effectively control ascites using the PD catheter at home. There were no postoperative infections. The placement of a temporary PD catheter during umbilical herniorrhaphy provides a method for effective control of ascites in patients with cirrhosis. The technique has several advantages including outpatient management during the postoperative period and for easy removal of the catheter when no longer needed.
authors.affiliation: Department of Surgery, Tulane Center for Abdominal Transplantation, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA.
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Slakey
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Benz
authors.forename: Shobha
authors.initials: S
authors.lastname: Joshi
authors.forename: Fredric G
authors.initials: FG
authors.lastname: Regenstein
authors.forename: Sander S
authors.initials: SS
authors.lastname: Florman
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000628:therapy; D002404:Catheterization; D005500:Follow-Up Studies; D006554:Hernia, Umbilical / Q000150:complications / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D019152:Paracentesis / Q000295:instrumentation; D010530:Peritoneal Dialysis / Q000379:methods*; D011182:Postoperative Care / Q000295:instrumentation; D011183:Postoperative Complications / Q000401:mortality; D012008:Recurrence