title: Management in patients with liver cirrhosis and an umbilical hernia.
abstract: BACKGROUND
  Optimal management in patients with umbilical hernias and liver cirrhosis with ascites is still under debate. The objective of this study was to compare the outcome in our series of operative versus conservative treatment of these patients.
  
  
  METHODS
  In the period between 1990 and 2004, 34 patients with an umbilical hernia combined with liver cirrhosis and ascites were identified from our hospital database. In 17 patients, treatment consisted of elective hernia repair, and 13 were managed conservatively. Four patients underwent hernia repair during liver transplantation.
  
  
  RESULTS
  Elective hernia repair was successful without complications and recurrence in 12 out of 17 patients. Complications occurred in 3 of these 17 patients, consisting of wound-related problems and recurrence in 4 out 17. Success rate of the initial conservative management was only 23%; hospital admittance for incarcerations occurred in 10 of 13 patients, of which 6 required hernia repair in an emergency setting. Two patients of the initially conservative managed group died from complications of the umbilical hernia. In the 4 patients that underwent hernia correction during liver transplantation, no complications occurred and 1 patient had a recurrence.
  
  
  CONCLUSIONS
  Conservative management of umbilical hernias in patients with liver cirrhosis and ascites leads to a high rate of incarcerations with subsequent hernia repair in an emergency setting, whereas elective repair can be performed with less morbidity and is therefore advocated.
authors.affiliation: Department of Surgery, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Hendrik A
authors.initials: HA
authors.lastname: Marsman
authors.forename: Joos
authors.initials: J
authors.lastname: Heisterkamp
authors.forename: Jens A
authors.initials: JA
authors.lastname: Halm
authors.forename: Hugo W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: Herold J
authors.initials: HJ
authors.lastname: Metselaar
authors.forename: Geert
authors.initials: G
authors.lastname: Kazemier
mesh_terms: D000368:Aged; D001201:Ascites / Q000209:etiology / Q000601:surgery*; D005260:Female; D006554:Hernia, Umbilical / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome