title: Management of umbilical hernia complicated with liver cirrhosis: an advocate of early and elective herniorrhaphy.
abstract: BACKGROUND
  Patients with umbilical hernias complicated by liver cirrhosis have an increased likelihood of complications following herniorrhaphy. The aim of this study was to investigate the clinical outcomes in patients with umbilical hernias complicated by liver cirrhosis.
  
  
  METHODS
  Between 2001 and 2010, 44 patients were enrolled in this study. The comparison between non-operative and operative group was performed. Patients who underwent emergency versus elective surgery were also compared.
  
  
  RESULTS
  Of the 44 patients, there were 33 men and 11 women. Thirty-one patients (70.5%) underwent surgery and 13 patients (29.5%) were treated conservatively. Overall morbidity and mortality rates following herniorrhaphy were 42% and 6.5%. The mean albumin level was significantly lower and total bilirubin, creatinine and mean model of end-stage liver disease score were significantly higher in non-operative group than in operative group. Combined resection was performed more frequently in the emergency group than in elective group. A significantly higher proportion of patients in emergency operation group had postoperative complications (P=0.01), especially ascites (P=0.02). The operative time and postoperative hospital stay were significantly shorter in the elective operation group than in emergency operation group.
  
  
  CONCLUSIONS
  Early, elective repair of umbilical hernias in cirrhotic patients should be advocated considering the hepatic reserve and patient's condition. Ascites control is the mainstay of post-operative management.
authors.affiliation: Department of Surgery, Korea University College of Medicine, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul, Republic of Korea.
authors.forename: Sae Byeol
authors.initials: SB
authors.lastname: Choi
authors.forename: Kwang Dae
authors.initials: KD
authors.lastname: Hong
authors.forename: Jin Suk
authors.initials: JS
authors.lastname: Lee
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Han
authors.forename: Wan Bae
authors.initials: WB
authors.lastname: Kim
authors.forename: Tae Jin
authors.initials: TJ
authors.lastname: Song
authors.forename: Sung Ock
authors.initials: SO
authors.lastname: Suh
authors.forename: Young Chul
authors.initials: YC
authors.lastname: Kim
authors.forename: Sang Yong
authors.initials: SY
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology; D017558:Elective Surgical Procedures / Q000009:adverse effects; D004630:Emergencies; D005260:Female; D006554:Hernia, Umbilical / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome