Evaluation of hernia repair operation in Child-Turcotte-Pugh class C cirrhosis and refractory ascites.
OBJECTIVE
Abdominal wall hernia is a common feature of decompensated liver cirrhosis and frequently causes life-threatening complications or severe pain. However, there have been no data reported on postoperative mortality, hepatic functional deterioration and recurrence rate according to Child-Turcotte-Pugh (CTP) class and to the presence of refractory ascites.


METHODS
The study population comprised 53 liver cirrhosis patients who underwent hernia repair operation. Comparisons were made of 30-day mortality among the different CTP classes, and between those with or without refractory ascites. Liver function was also analyzed just before the operation, in the immediate postoperative period, and in the remote postoperative period.


RESULTS
Seventeen patients were in CTP class A, 27 patients in class B, and 9 patients in class C. The median follow-up duration was 24 months. There was single 30-day postoperative mortality in class C, and no CTP class deterioration after 30 days of operation. There was no mortality or recurrences in 17 patients with medically refractory ascites. The difference in 30-day mortality according to CTP class and the presence of refractory ascites did not show statistical significance (P = 0.17 and 0.97, respectively).


CONCLUSIONS
Hernia operation could be done safely in CTP class A and B with low rate of recurrences, and there was no definitive increase in the operative risk in class C. In addition, refractory ascites did not increase operative risk and recurrence rate. Therefore, surgical repair might be recommended even in patients with refractory ascites and poor hepatic function to prevent life-threatening complications or severe pain.
Park
Joo Kyung
JK
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Lee
Sang Hyub
SH
Yoon
Won Jae
WJ
Lee
Jun Kyu
JK
Park
Su Cheol
SC
Park
Bum Joon
BJ
Jung
Yong Jin
YJ
Kim
Byeong Gwan
BG
Yoon
Jung-Hwan
JH
Kim
Chung Yong
CY
Ha
Jongwon
J
Park
Kyu Joo
KJ
Kim
Yoon Jun
YJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000145:classification / Q000150:complications*; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies