title: Successful surgical management of ruptured umbilical hernias in cirrhotic patients.
abstract: Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual, but potentially life-threatening complication, with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical repair. Management options include primary surgical repair with or without concomitant portal venous system decompression for the control of the ascites. We present a retrospective analysis of our centre's experience over the last 6 years. Our cohort consisted of 11 consecutive patients (median age: 53 years, range: 36-63 years) with advanced hepatic cirrhosis and refractory ascites. Appropriate patient resuscitation and optimisation with intravenous fluids, prophylactic antibiotics and local measures was instituted. One failed attempt for conservative management was followed by a successful primary repair. In all cases, with one exception, a primary repair with non-absorbable Nylon, interrupted sutures, without mesh, was performed. The perioperative complication rate was 25% and the recurrence rate 8.3%. No mortality was recorded. Median length of hospital stay was 14 d (range: 4-31 d). Based on our experience, the management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible without the use of transjugular intrahepatic portosystemic shunt routinely in the preoperative period, provided that meticulous patient optimisation is performed.
authors.affiliation: Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs, Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Chatzizacharias
authors.affiliation: Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs, Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Bradley
authors.affiliation: Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs, Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Harper
authors.affiliation: Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs, Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Butler
authors.affiliation: Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs, Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Asif
authors.initials: A
authors.lastname: Jah
authors.affiliation: Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs, Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Huguet
authors.affiliation: Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs, Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Raaj K
authors.initials: RK
authors.lastname: Praseedom
authors.affiliation: Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs, Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Allison
authors.affiliation: Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs, Department of HPB and Transplant Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Gibbs
mesh_terms: D000328:Adult; D001201:Ascites / Q000209:etiology; D004739:England; D005240:Feasibility Studies; D005260:Female; D006554:Hernia, Umbilical / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013536:Suture Techniques / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ascites; Cirrhosis; Rupture; Transjugular intrahepatic portosystemic shunting; Umbilical hernia