title: Evaluation of hernia repair operation in Child-Turcotte-Pugh class C cirrhosis and refractory ascites.
abstract: 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.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Joo Kyung
authors.initials: JK
authors.lastname: Park
authors.forename: Sang Hyub
authors.initials: SH
authors.lastname: Lee
authors.forename: Won Jae
authors.initials: WJ
authors.lastname: Yoon
authors.forename: Jun Kyu
authors.initials: JK
authors.lastname: Lee
authors.forename: Su Cheol
authors.initials: SC
authors.lastname: Park
authors.forename: Bum Joon
authors.initials: BJ
authors.lastname: Park
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Jung
authors.forename: Byeong Gwan
authors.initials: BG
authors.lastname: Kim
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Yoon
authors.forename: Chung Yong
authors.initials: CY
authors.lastname: Kim
authors.forename: Jongwon
authors.initials: J
authors.lastname: Ha
authors.forename: Kyu Joo
authors.initials: KJ
authors.lastname: Park
authors.forename: Yoon Jun
authors.initials: YJ
authors.lastname: Kim
mesh_terms: 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