title: A prospective study on elective umbilical hernia repair in patients with liver cirrhosis and ascites.
abstract: BACKGROUND
  Patients with both cirrhosis and ascites have a 20% risk of developing umbilical hernia. A retrospective study from our center comparing conservative management of umbilical hernia with elective repair in these patients showed a significant risk of mortality as a result of hernia incarceration in conservatively treated patients. The goal of this study was to assess the safety and efficacy of elective umbilical hernia repair in these patients prospectively.
  
  
  METHODS
  Patients with liver cirrhosis and ascites presenting with an umbilical hernia were included in this study. For all patients, the expected time to liver transplantation was more than 3 months, and they did not have a patent umbilical vein in the hernia sac. The following data were collected prospectively for all patients: Child-Pugh-Turcotte (CPT) classification, model for end-stage liver disease (MELD) score, kidney failure, cardiovascular comorbidity, operation-related complications, and duration of hospital stay. Mortality rates were registered in hospital records and verified in government records during follow-up. Mortality rates were registered in hospital records and verified in government records during follow-up. On completion of the study, a retrospective survey was performed to search for any patients who met the study inclusion criteria but were left out of the study cohort.
  
  
  RESULTS
  In total, 30 patients (25 males) underwent operation at a mean age of 58 years (standard deviation [SD] ± 9 years). Of these 30 patients, 6 were classified as CPT grade A (20%), 19 (63%) as grade B, and 5 (17%) as grade C. The patients' median MELD score was 12 (interquartile range [IQR], 8-16). In 10 (33%) of the 30 patients hernia repair was performed with mesh. The median duration of hospital stay was 3 days (IQR, 2-4). None of the patients were admitted to the intensive care unit. Postoperative complications included pneumonia and decompensation of cirrhosis (1 case each,) resulting in prolonged hospital stay for those 2 patients. After a median follow-up period of 25 months (IQR, 14-34), 2 (7%) of the 30 patients died; neither of the deaths were attributable to the umbilical hernia repair. A total of 2 patients suffered recurrence.
  
  
  CONCLUSIONS
  Elective umbilical hernia repair is safe and the preferred approach in cirrhotic patients with ascites.
authors.affiliation: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Hasan H
authors.initials: HH
authors.lastname: Eker
authors.forename: G H
authors.initials: GH
authors.lastname: van Ramshorst
authors.forename: B
authors.initials: B
authors.lastname: de Goede
authors.forename: H W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: H J
authors.initials: HJ
authors.lastname: Metselaar
authors.forename: R A
authors.initials: RA
authors.lastname: de Man
authors.forename: J F
authors.initials: JF
authors.lastname: Lange
authors.forename: G
authors.initials: G
authors.lastname: Kazemier
mesh_terms: D000368:Aged; D001201:Ascites / Q000150:complications* / Q000175:diagnosis; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006554:Hernia, Umbilical / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D018570:Risk Assessment; D017751:Safety Management; D012720:Severity of Illness Index; D016896:Treatment Outcome