Pinheiro RS, Andraus W, Waisberg DR, Nacif LS, Ducatti L, Rocha-Santos V, Diniz MA, Arantes RM, Lerut J, D'Albuquerque LAC. Abdominal hernias in cirrhotic patients: Surgery or conservative treatment? Results of a prospective cohort study in a high volume center: Cohort study.
Ann Med Surg (Lond) 2019;
49:9-13. [PMID:
31853365 PMCID:
PMC6911966 DOI:
10.1016/j.amsu.2019.11.009]
[Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/13/2019] [Indexed: 01/15/2023] Open
Abstract
Background
Surgical treatment of abdominal hernias in cirrhotics is often delayed due to the higher morbidity and mortality associated with the underlying liver disease. Some patients are followed conservatively and only operated on when complications occur (“wait and see” approach). The aim of this study is to compare outcomes of cirrhotic patients undergoing conservative non-operative care or elective hernia repair.
Methods
A prospective observational study including 246 cirrhotic patients with abdominal hernia was carried out. Patients were given the option to select their treatment: elective hernia repair or conservative non-operative care. Demographics, characteristics of underlying liver disease, type of hernia, complications and mortality were analyzed. During follow-up of patients who opted for the “wait and see” approach, emergency hernia repair was performed in case of hernia complications.
Results
Elective hernia repair was performed in 57 patients and 189 patients were kept in conservative care, of which 43 (22.7%) developed complications that required emergency hernia repair. Elective surgery provided better five-years survival than conservative care (80% vs. 62%; p = 0.012). Multivariate analysis identified multiples hernias [Hazards Ratio (HR):6.7, p < 0.001] and clinical follow-up group (HR 3.62, p = 0.005) as risk factors for mortality. Among patients undergoing surgical treatment, multivariate analysis revealed MELD>11 (HR 7.8; p = 0.011) and emergency hernia repair (HR 5.35; p = 0.005) as independent risk factors for 30-day mortality.
Conclusions
Elective hernia repair offers an acceptable morbidity and ensures longer survival. “Wait and see” approach jeopardizes cirrhotic patients and should be avoided, given the higher incidence of emergency surgery due to hernia complications.
Prospective study comparing “wait and see” approach with elective surgical repair of abdominal hernias in cirrhotic patients.
About 22.7% (n = 43) of patients under conservative treatment developed hernia complications requiring emergency hernia repair.
Five-year survival was higher in elective repair group than in conservative treatment (80% vs. 62%; p = 0.012).
Among patients undergoing hernia repair MELD>11 and emergency surgery were independent risk factors for 30-day mortality.
“Wait and see” approach jeopardizes cirrhotic patients, as a high incidence of emergency surgery negatively impact survival.
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