title: Umbilical hernia management during liver transplantation.
abstract: OBJECTIVE
  Patients with liver cirrhosis scheduled for liver transplantation often present with a concurrent umbilical hernia. Optimal management of these patients is not clear. The objective of this study was to compare the outcomes of patients who underwent umbilical hernia correction during liver transplantation through a separate infra-umbilical incision with those who underwent correction through the same incision used to perform the liver transplantation.
  
  
  METHODS
  In the period between 1990 and 2011, all 27 patients with umbilical hernia and liver cirrhosis who underwent hernia correction during liver transplantation were identified in our hospital database. In 17 cases, umbilical hernia repair was performed through a separate infra-umbilical incision (separate incision group) and 10 were corrected from within the abdominal cavity without a separate incision (same incision group). Six patients died during follow-up; no deaths were attributable to intraoperative umbilical hernia repair. All 21 patients who were alive visited the outpatient clinic to detect recurrent umbilical hernia.
  
  
  RESULTS
  One recurrent umbilical hernia was diagnosed in the separate incision group (6 %) and four (40 %) in the same incision group (p = 0.047). Two patients in the same incision group required repair of the recurrent umbilical hernia; one of whom underwent emergency surgery for bowel incarceration. The one recurrent hernia in the separate incision group was corrected electively.
  
  
  CONCLUSIONS
  In the event of liver transplantation, umbilical hernia repair through a separate infra-umbilical incision is preferred over correction through the same incision used to perform the transplantation.
authors.affiliation: Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. b.degoede@erasmusmc.nl
authors.forename: B
authors.initials: B
authors.lastname: de Goede
authors.forename: B J H
authors.initials: BJ
authors.lastname: van Kempen
authors.forename: W G
authors.initials: WG
authors.lastname: Polak
authors.forename: R J
authors.initials: RJ
authors.lastname: de Knegt
authors.forename: J N L
authors.initials: JN
authors.lastname: Schouten
authors.forename: J F
authors.initials: JF
authors.lastname: Lange
authors.forename: H W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: H J
authors.initials: HJ
authors.lastname: Metselaar
authors.forename: G
authors.initials: G
authors.lastname: Kazemier
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000328:Adult; D005260:Female; D006554:Hernia, Umbilical / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies