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Kykalos S, Machairas N, Ntikoudi E, Dorovinis P, Molmenti EP, Sotiropoulos GC. Inguinal Hernias in Cirrhotic Patients: From Diagnosis to Treatment. Surg Innov 2021; 28:620-627. [PMID: 33599535 DOI: 10.1177/1553350621995058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cirrhosis has a strong association with abdominal wall hernias, especially in the presence of concomitant ascites. Major predisposing factors for hernia formation in this particular group of patients include increased intra-abdominal pressure and decreased muscle mass due to poor nutrition. Management of these patients is highly challenging and requires an experienced multidisciplinary surgical and medical approach. The aim of our review is to clarify crucial diagnostic and management approaches. Crucial medical and technical issues on this topic are widely discussed with special focus on indication, timing, and type of surgical repair, with an additional reference to the actual role of laparoscopy.
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Affiliation(s)
- Stylianos Kykalos
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
| | - Nikolaos Machairas
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
| | | | - Panagiotis Dorovinis
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
| | - Ernesto P Molmenti
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Georgios C Sotiropoulos
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
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Study on in vitro Toxicity of Biometal(II) Monensinates Against Rat Zajdela Liver Tumour. CHEMISTRY-DIDACTICS-ECOLOGY-METROLOGY 2021. [DOI: 10.2478/cdem-2020-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
The ability of Monensic acid A (MonH∙H2O) and its neutral metal complexes [M(Mon)2(H2O)2]with ions of Mg2+, Ca2+, Mn2+, Co2+, Ni2+ and Zn2+ to decrease viability and proliferation of primary cell cultures, originating from a chemically induced transplantable liver tumour of Zajdela in rats, and bone marrow cells from the same tumour-bearers, was evaluated. Experimental data revealed that manganese(II) and nickel(II) complexes of Monensin A are relatively more selective against the tumour as compared to the healthy bone marrow cells.
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Li J, Shao X, Cheng T, Ji Z. Inguinal hernia repair in cirrhotic patients with ascites. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2020. [DOI: 10.4103/ijawhs.ijawhs_11_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Safety and effectiveness of inguinal hernia repair in patients with liver cirrhosis: a retrospective study and literature review. Hernia 2019; 24:489-494. [PMID: 31773547 DOI: 10.1007/s10029-019-02087-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/03/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE Inguinal hernia is a common feature of decompensated liver cirrhosis and a frequent cause of life-threatening complications. The traditional treatment of inguinal hernia in patients with liver cirrhosis includes non-operative management; however, emerging data suggest elective surgical repair as a preferable approach. Therefore, we aimed to assess the outcomes of inguinal hernia repair in patients with liver cirrhosis and describe their clinical characteristics. METHODS In this retrospective study, we included a total of 28 consecutive patients with liver cirrhosis who underwent inguinal hernia repair between March 2000 and May 2019 at the First People's Hospital of Xiaoshan, Hangzhou, China. We also reviewed the literature on inguinal hernia repair in patients with liver cirrhosis. RESULTS Emergency surgery for complicated hernia was performed in 17.9% of the study patients. Two patients developed major complications including wound hematoma in 1, who required reoperation, and gastrointestinal tract hemorrhage in the other patient, who required blood transfusion. Further, minor complications developed in 6 patients, including wound seroma in 1 and scrotal swelling in 5. Emergency hernia repair was found to be associated with a higher complication rate than elective surgery in patients with liver cirrhosis. CONCLUSION Elective surgery for inguinal hernia repair in patients with liver cirrhosis appears to be successful and might be associated with a lower complication rate than emergency surgery. Inguinal hernia repair is recommended for patients with liver cirrhosis to prevent the development of life-threatening complications.
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Kim SW, Kim MA, Chang Y, Lee HY, Yoon JS, Lee YB, Cho EJ, Lee JH, Yu SJ, Yoon JH, Park KJ, Kim YJ. Prognosis of surgical hernia repair in cirrhotic patients with refractory ascites. Hernia 2019; 24:481-488. [PMID: 31512088 DOI: 10.1007/s10029-019-02043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Abdominal wall hernias are common in patients with ascites. Elective surgical repair is recommended for the treatment of abdominal wall hernias. However, surgical hernia repair in cirrhotic patients with refractory ascites is controversial. In this study, we aimed to evaluate the outcomes of elective surgical hernia repair in patients with liver cirrhosis with and without refractory ascites. METHOD From January 2005 to June 2018, we retrospectively reviewed the records of consecutive patients with liver cirrhosis who underwent a surgical hernia repair. RESULTS This study included 107 patients; 31 patients (29.0%) had refractory ascites. Preoperatively, cirrhotic patients with refractory ascites had a higher median model for end-stage liver disease (MELD) score (13.0 vs 11.0, P = 0.001) than those without refractory ascites. The 30-day mortality rate (3.2% vs 0%, P = 0.64) and the risk of recurrence (hazard ratio 0.410; 95% CI 0.050-3.220; P = 0.39) did not differ significantly between cirrhotic patients with refractory ascites and cirrhotic patients without refractory ascites. Among cirrhotic patients with refractory ascites, albumin (P = 0.23), bilirubin (P = 0.37), creatinine (P = 0.97), and sodium levels (P = 0.35) did not change significantly after surgery. CONCLUSION In advanced liver cirrhosis patients with refractory ascites, hernias can be safely treated with elective surgical repair. Mortality rate within 30 days did not differ by the presence or absence of refractory ascites. Elective hernia repair might be beneficial for treatment of abdominal wall hernia in cirrhotic patients with refractory ascites.
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Affiliation(s)
- S W Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - M A Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Y Chang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - H Y Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, South Korea
| | - J S Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Y B Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - E J Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - J-H Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - S J Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - J-H Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - K J Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Y J Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Salamone G, Licari L, Guercio G, Campanella S, Falco N, Scerrino G, Bonventre S, Geraci G, Cocorullo G, Gulotta G. The abdominal wall hernia in cirrhotic patients: a historical challenge. World J Emerg Surg 2018; 13:35. [PMID: 30065783 PMCID: PMC6064098 DOI: 10.1186/s13017-018-0196-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/18/2018] [Indexed: 12/20/2022] Open
Abstract
Background The incidence rate of abdominal wall hernia is 20–40% in cirrhotic patients. A surgical approach was originally performed only if complication signs and symptoms occurred. Several recent studies have demonstrated the usefulness of elective surgery. During recent decades, the indications for surgical timing have changed. Methods Cirrhotic patients with abdominal hernia who underwent surgical operation for abdominal wall hernia repair at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2010 and September 2016 were identified in a prospective database, and the data collected were retrospectively reviewed; patients’ medical and surgical records were collected from charts and surgical and intensive care unit (ICU) registries. Postoperative morbidity was determined through the Clavien-Dindo classification. Cirrhosis severity was estimated by the Child-Pugh-Turcotte (CPT) score and MELD (model of end-stage liver disease) score. Postoperative mortality was considered up to 30 days after surgery. A follow-up period of at least 1 year was used to evaluate hernia recurrence. Results The univariate and multivariate analyses demonstrated the unique independent risk factors for the development of postsurgical morbidity (emergency surgery (OR 6.42; p 0.023), CPT class C (OR 3.72; p 0.041), American Society of Anesthesiologists (ASA) score ≥ 3 (OR 4.72; p 0.012) and MELD ≥ 20 (OR 5.64; p 0.009)) and postsurgical mortality (emergency surgery (OR 10.32; p 0.021), CPT class C (OR 5.52; p 0.014), ASA score ≥ 3 (OR 8.65; p 0.018), MELD ≥ 20 (OR 2.15; p 0.02)). Conclusions Concerning abdominal wall hernia repair in cirrhotic patients, the worst outcome is associated with emergency surgery and with uncontrolled disease. The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction.
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Affiliation(s)
- Giuseppe Salamone
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Leo Licari
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Giovanni Guercio
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Sofia Campanella
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Nicolò Falco
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Gregorio Scerrino
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Sebastiano Bonventre
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Girolamo Geraci
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Gianfranco Cocorullo
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Gaspare Gulotta
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
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Wang R, Qi X, Peng Y, Deng H, Li J, Ning Z, Dai J, Hou F, Zhao J, Guo X. Association of umbilical hernia with volume of ascites in liver cirrhosis: a retrospective observational study. J Evid Based Med 2016; 9:170-180. [PMID: 27792277 DOI: 10.1111/jebm.12225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/31/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Umbilical hernia is a common abdominal complication in cirrhotic patients with ascites. Our study aimed to evaluate the correlation of umbilical hernia with the volume of ascites. METHODS Cirrhotic patients that underwent axial abdominopelvic computed tomography (CT) scans at our hospital between June 2012 and June 2014 were eligible. All CT images were reviewed to confirm the presence of umbilical hernia. The volume of ascites was estimated by five-point method. RESULTS One hundred and fifty-seven patients were enrolled into this study. Among them, 101 patients had ascites and 6 patients had umbilical hernia. Alkaline phosphatase (AKP) and serum sodium were significantly lower in patients with umbilical hernia (P = 0.008, P = 0.011, respectively). Child-Pugh scores and the volume of ascites were significantly higher in patients with umbilical hernia (P = 0.03, P < 0.0001, respectively). Correlation analysis demonstrated that the volume of ascites, Child-Pugh scores, and blood ammonia had positive correlations with umbilical hernia (r = 0.4579, P < 0.0001; r = 0.175, P = 0.03; r = 0.342, P = 0.001, respectively) and that serum sodium had a negative correlation with umbilical hernia (r = -0.203, P = 0.011). In patients with ascites ≥2000 mL, only AKP was significantly associated with umbilical hernia (P = 0.0497). No variables were significantly associated with umbilical hernia in a subgroup analysis of patients matched according to the volume of ascites. CONCLUSIONS The volume of ascites has a positive correlation with umbilical hernia. However, the factors associated with umbilical hernia in patients with severe ascites remain unclear.
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Affiliation(s)
- Ran Wang
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
| | - Ying Peng
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Han Deng
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Jing Li
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Zheng Ning
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Junna Dai
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Feifei Hou
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Jiancheng Zhao
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China
- Postgraduate College, Dalian Medical University, Dalian, China
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Coelho JCU, Claus CMP, Campos ACL, Costa MAR, Blum C. Umbilical hernia in patients with liver cirrhosis: A surgical challenge. World J Gastrointest Surg 2016; 8:476-482. [PMID: 27462389 PMCID: PMC4942747 DOI: 10.4240/wjgs.v8.i7.476] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/02/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites. Due to the enormous intraabdominal pressure secondary to the ascites, umbilical hernia in these patients has a tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge. Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, such as wound infection, evisceration, ascites drainage, and peritonitis. Intermittent paracentesis, temporary peritoneal dialysis catheter or transjugular intrahepatic portosystemic shunt may be necessary to control ascites. Hernia repair is indicated in patients in whom medical treatment is effective in controlling ascites. Patients who have a good perspective to be transplanted within 3-6 mo, herniorrhaphy should be performed during transplantation. Hernia repair with mesh is associated with lower recurrence rate, but with higher surgical site infection when compared to hernia correction with conventional fascial suture. There is no consensus on the best abdominal wall layer in which the mesh should be placed: Onlay, sublay, or underlay. Many studies have demonstrated several advantages of the laparoscopic umbilical herniorrhaphy in cirrhotic patients compared with open surgical treatment.
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Hepatic Failure. PRINCIPLES OF ADULT SURGICAL CRITICAL CARE 2016. [PMCID: PMC7123541 DOI: 10.1007/978-3-319-33341-0_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The progression of liver disease can cause several physiologic derangements that may precipitate hepatic failure and require admission to an intensive care unit. The underlying pathology may be acute, acute-on chronic, or chronic in nature. Liver failure may manifest with a variety of clinical signs and symptoms that need prompt attention. The compromised synthetic and metabolic activity of the failing liver affects all organ systems, from neurologic to integumentary. Supportive care and specific therapies should be instituted in order to improve outcome and minimize time of recovery. In this chapter we will discuss the definition, clinical manifestations, workup, and management of acute and chronic liver failure and the general principles of treatment of these patients. Management of liver failure secondary to certain common etiologies will also be presented. Finally, liver transplantation and alternative therapies will also be discussed.
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Kwon HJ, Chun JM, Kim SG, Kim HK, Huh S, Hwang YJ. Deceased donor liver transplantation performed one week after small bowel resection for complicated umbilical hernia: a case report. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2015; 18:94-6. [PMID: 26155258 PMCID: PMC4492321 DOI: 10.14701/kjhbps.2014.18.3.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/03/2014] [Accepted: 08/08/2014] [Indexed: 11/17/2022]
Abstract
Emergent abdominal surgery in cirrhotic patients with ascites can result in dismal postoperative outcomes such as sepsis and hepatic failure. In the present case, small bowel resection followed by anastomosis by the hand-sewn method was performed for small bowel strangulation caused by an umbilical hernia; deceased donor liver transplantation was performed one week after the bowel resection because of deterioration of hepatic function. To the best of our knowledge, this is the first case of liver transplantation performed at only one week after small bowel resection; and although we obtained a good result, the optimal time to perform liver transplantation in this situation requires further evaluation.
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Affiliation(s)
- Hyung Jun Kwon
- Hepatobiliary-Pancreatic Center, Kyungpook National University Medical Center, Korea
| | - Jae Min Chun
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Geol Kim
- Hepatobiliary-Pancreatic Center, Kyungpook National University Medical Center, Korea
| | - Hyung-Kee Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Huh
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yun-Jin Hwang
- Hepatobiliary-Pancreatic Center, Kyungpook National University Medical Center, Korea
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Andraus W, Pinheiro RS, Lai Q, Haddad LBP, Nacif LS, D'Albuquerque LAC, Lerut J. Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality. BMC Surg 2015; 15:65. [PMID: 25990110 PMCID: PMC4443633 DOI: 10.1186/s12893-015-0052-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 05/11/2015] [Indexed: 02/07/2023] Open
Abstract
Background Patients with cirrhosis have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical management strategy as well as timing of abdominal hernia repair remains controversial. Methods A cohort study of 67 cirrhotic patients who underwent hernia repair during the period of January 1998-December 2009 at the University Hospital of Sao Paulo were included. After meeting study criteria, a total of 56 patients who underwent 61 surgeries were included in the final analysis. Patient characteristics, morbidity (Clavien score), mortality, Child-Turcotte-Pugh score, MELD score, use of prosthetic material, and elective or emergency surgery have been analysed with regards to morbidity and 30-day mortality. Results The median MELD score of the patient population was 14 (range: 6 to 24). Emergency surgery was performed in 34 patients because of ruptured hernia (n = 13), incarceration (n = 10), strangulation (n = 4), and skin necrosis or ulceration (n = 7). Elective surgery was performed in 27 cases. After a multivariable analysis, emergency surgery (OR 7.31; p 0.017) and Child-Pugh C (OR 4.54; p 0.037) were risk factors for major complications. Moreover, emergency surgery was a unique independent risk factor for 30-day mortality (OR 10.83; p 0.028). Conclusions Higher morbidity and mortality are associated with emergency surgery in advanced cirrhotic patients. Therefore, using cirrhosis as a contraindication for hernia repair in all patients may be reconsidered in the future, especially after controlling ascites and in those patients with hernias that are becoming symptomatic or show signs of possible skin necrosis and rupture. Future prospective randomized studies are needed to confirm this surgical strategy.
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Affiliation(s)
- Wellington Andraus
- Digestive Organs Transplant Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
| | - Rafael Soares Pinheiro
- Digestive Organs Transplant Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Quirino Lai
- Department of Hepatic Surgery and Liver Transplantation, Azienda Universitario-ospedaliera Pisana, Pisa, Italy
| | - Luciana B P Haddad
- Digestive Organs Transplant Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Lucas S Nacif
- Digestive Organs Transplant Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Luiz Augusto C D'Albuquerque
- Digestive Organs Transplant Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Jan Lerut
- Starzl Unit of Abdominal Transplantation, University Hospital of Saint Luc, Université Catholique of Louvain, Brussels, Belgium
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Abstract
BACKGROUND The optimal treatment for abdominal wall hernias in the setting of ascites is not clear. We describe our experience with emergent surgery for hernias in patients with cirrhosis and ascites and assess variables associated with poor short- and long-term outcomes to inform decisions about aggressive early repair. METHODS We performed a retrospective review of all emergency abdominal wall hernia repairs admitted from the emergency department from January 2000 to December 2011 in all patients with ascites caused by liver cirrhosis. Demographic data, comorbidities, complications, operative details, hospital length of stay, and admission model of end-stage liver disease (MELD) score was determined. Follow-up was detailed via comprehensive liver service electronic records. RESULTS There were 69 emergent hernia surgeries in 68 patients during the study period. There were two early deaths (both MELD score> 20). Multivariate analysis revealed MELD score (18% increase in risk with each point of MELD), preoperative anemia (sevenfold increase in risk), and preoperative small bowel obstruction (ninefold increase in risk) as predictive factors of major complication. In patients with MELD score greater than 10, morbidity was more than 50%, and major morbidity is greater than 12% when MELD score is greater than 20. CONCLUSION Emergent hernia surgery in patients with ascites has low mortality but high morbidity and requires intense use of resources. To decrease the incidence of emergent hernia surgery, we recommend the aggressive use of elective repair. Emergent hernia repair, when necessary, should be performed at experienced centers and must include adequate ascites control with diuretic therapy and percutaneous paracentesis. Preoperative anemia and electrolyte abnormalities should be aggressively treated. Finally, while wound complications are common and frequently require reintervention, they are not associated with increased mortality. LEVEL OF EVIDENCE Prognostic and epidemiologic study, level V.
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Smith MT, Rase B, Woods A, Trotter J, Gipson M, Kondo K, Ray C, Durham J. Risk of hernia incarceration following transjugular intrahepatic portosystemic shunt placement. J Vasc Interv Radiol 2013; 25:58-62. [PMID: 24269791 DOI: 10.1016/j.jvir.2013.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 09/04/2013] [Accepted: 09/05/2013] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Hernia complications after creation of a transjugular intrahepatic portosystemic shunt (TIPS) have been reported, although the incidence of this complication is unknown. This study was designed to determine the incidence, morbidity, and outcome of hernia complications in patients with preexisting abdominal or inguinal hernias after TIPS creation. MATERIALS AND METHODS The medical records of 244 consecutive patients undergoing TIPS creation between 1999 and 2007 at a single institution were reviewed. The study population was 57 patients (23%) with a preprocedural abdominal or inguinal hernia. The investigated outcome was small bowel obstruction or postprocedural incarceration of a preexisting hernia. Demographic and procedural variables were evaluated for an associated increased risk of hernia complications. RESULTS Hernia complications developed in 25% of patients (14 of 57) after TIPS creation at a mean presentation of 62 days (range, 2-588 d). Thirteen complications (93%) required emergent surgery, of which four (29%) required bowel resection for necrosis. There were no resulting deaths. Ninety-eight percent of patients with a hernia complication had the procedure to treat refractory ascites. The indication of refractory ascites was significantly associated with the risk of a hernia complication (P = .002). CONCLUSIONS A 25% incidence of hernia complications following TIPS creation in patients being treated for refractory ascites is higher than expected; emergent surgery is required in most cases. Further investigation to formulate a plan for elective management is warranted.
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Affiliation(s)
- Mitchell T Smith
- Department of Radiology, Division of Interventional Radiology, University of Colorado Denver, 12700 E. 19th Ave, Room P15-1205, Aurora, CO 80045.
| | - Benjamin Rase
- Department of Radiology, University of Colorado School of Medicine, Denver, Colorado
| | - Alyn Woods
- Department of Radiology, David Grant Medical Center, Travis AFB, California
| | - James Trotter
- Liver Transplantation Center, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Matt Gipson
- Department of Radiology, Division of Interventional Radiology, University of Colorado Denver, 12700 E. 19th Ave, Room P15-1205, Aurora, CO 80045
| | - Kimi Kondo
- Department of Radiology, Division of Interventional Radiology, University of Colorado Denver, 12700 E. 19th Ave, Room P15-1205, Aurora, CO 80045
| | - Charles Ray
- Department of Radiology, Division of Interventional Radiology, University of Colorado Denver, 12700 E. 19th Ave, Room P15-1205, Aurora, CO 80045
| | - Janette Durham
- Department of Radiology, Division of Interventional Radiology, University of Colorado Denver, 12700 E. 19th Ave, Room P15-1205, Aurora, CO 80045
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Pandey CK, Karna ST, Pandey VK, Tandon M, Singhal A, Mangla V. Perioperative risk factors in patients with liver disease undergoing non-hepatic surgery. World J Gastrointest Surg 2012; 4:267-74. [PMID: 23494910 PMCID: PMC3596521 DOI: 10.4240/wjgs.v4.i12.267] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 08/25/2012] [Accepted: 12/20/2012] [Indexed: 02/06/2023] Open
Abstract
The patients with liver disease present for various surgical interventions. Surgery may lead to complications in a significant proportion of these patients. These complications may result in considerable morbidity and mortality. Preoperative assessment can predict survival to some extent in patients with liver disease undergoing surgical procedures. A review of literature suggests nature and the type of surgery in these patients determines the peri-operative morbidity and mortality. Optimization of premorbid factors may help to reduce perioperative mortality and morbidity. The purpose of this review is to discuss the effect of liver disease on perioperative outcome; to understand various risk scoring systems and their prognostic significance; to delineate different preoperative variables implicated in postoperative complications and morbidity; to establish the effect of nature and type of surgery on postoperative outcome in patients with liver disease and to discuss optimal anaesthesia strategy in patients with liver disease.
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Affiliation(s)
- Chandra Kant Pandey
- Chandra Kant Pandey, Sunaina Tejpal Karna, Vijay Kant Pandey, Manish Tandon, Amit Singhal, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India
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Silva FD, Andraus W, Pinheiro RSN, Arantes-Junior RM, Lemes MPL, Ducatti LDSES, D'albuquerque LAC. Hérnias abdominais e inguinais em pacientes cirróticos: qual é a melhor conduta? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2012; 25:52-5. [DOI: 10.1590/s0102-67202012000100012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUÇÃO: Tradicionalmente os procedimentos abdominais eletivos em pacientes cirróticos têm sido amplamente desencorajados graças à elevada morbi-mortalidade consequente às complicações da cirrose, descritas por diversos autores. Outros serviços, em contrapartida, obtiveram resultados distintos, advogando a favor de cirurgia eletiva. MÉTODOS: Uma revisão de artigos utilizando-se a palavras "abdominal wall hernia" e "cirrhotic patients" foi realizada na base de dados PubMed. Dos resultados obtidos, 28 artigos foram considerados para elaboração desta revisão. RESULTADOS: Pôde-se observar que a incidência de hérnias em parede abdominal é relativamente elevada em pacientes cirróticos, sendo que muitas delas têm evolução desfavorável e requerem tratamento cirúrgico específico. Com o advento do sistema de alocação de órgãos baseados no escore de MELD, muitos centros estão repensando suas condutas em situações como esta, dado que muitos dos pacientes em questão encontram-se em lista de espera para transplante hepático. Dessa forma a cirurgia eletiva tem conquistado maior papel no manejo desta condição com intuito de diminuir morbi-mortalidade nesses pacientes. Além disso, a qualidade de vida mostrou-se um importante fator a ser considerado, estando muito prejudicada nesta condição. CONCLUSÃO: Poucos estudos com grandes amostragens foram conduzidos até o momento e não há consenso sobre qual conduta é a mais indicada levando em consideração taxas de morbi-mortalidade.
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Abstract
The most common complications of umbilical hernias in patients with cirrhosis and ascites include leakage, ulceration, rupture and incarceration. If such a complication is present, there is a high mortality rate after surgical repair. Elective repair is the most effective choice, as it prevents complications with a lower mortality. However, the control of ascites before and/or after repair is mandatory but may not always be possible with diuretics and paracentesis. Portal decompression by transjugular intrahepatic portosystemic shunt (TIPS) with better control of ascites may allow these patients to undergo surgery. Patients with cirrhosis and umbilical hernias should be referred for consideration of an elective surgical repair with mesh, preferably after optimal management of ascites. There should be a low threshold for placement of a TIPS to facilitate surgery and reduce the chance of severe recurrence of ascites. If surgery is contraindicated, a TIPS must be considered for control of ascites.
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Oh HK, Kim H, Ryoo S, Choe EK, Park KJ. Inguinal Hernia Repair in Patients with Cirrhosis is not Associated with Increased Risk of Complications and Recurrence. World J Surg 2011; 35:1229-33; discussion 1234. [DOI: 10.1007/s00268-011-1007-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Andraus W, Sepulveda A, Pinheiro RSN, Teixeira AR, D'Albuquerque LAC. Management of uncommon hernias in cirrhotic patients. Transplant Proc 2010; 42:1724-8. [PMID: 20620510 DOI: 10.1016/j.transproceed.2010.02.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 01/17/2010] [Accepted: 02/26/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Abdominal hernias are a common disease among cirrhotic patients, because of malnutrition and persistently high intra-abdominal pressure due to ascites. When tense ascites is present, life-threatening complications are likely to occur. In such cases, the morbidity and mortality rates are high. OBJECTIVE We describe 3 cirrhotic patients with rare complicated hernias that needed surgical repair. We discuss optimal timing for surgical approaches and the necessity of ascites control before surgery, as well as the technical details of the procedures. METHOD Review of hospital charts of selected rare cases of herniae in cirrhotic patients. CONCLUSION Elective surgical approaches can treat even uncommon hernias in cirrhotic patients with good results.
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Affiliation(s)
- W Andraus
- Department of Gastroenterology, Sao Paulo University School of Medicine, Sao Paulo, Brazil
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Khan MR, Kassi M, Janjua SA. Abdominal wall hernia repair in cirrhotic patients: outcomes seen at a tertiary care hospital in a developing country. Trop Doct 2009; 40:5-8. [PMID: 19850608 DOI: 10.1258/td.2009.090099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The outcome of hernia repair in patients with cirrhosis remains poor when compared to non-cirrhotics. The aim of our study was to evaluate the outcome of hernia repair in cirrhotic patients at our tertiary care hospital located in a developing country. A total of 61 patients with cirrhosis underwent hernia repair from January 2001 to December 2007 at our hospital. The mean age of the patients was 52 years and there were 30 males. Early postoperative complications were noted in 20 (33%) patients including two mortalities. The incidence of early complications was higher (71%) in patients with Child class C cirrhosis as compared to patients with either Child class A or B cirrhosis (21%), and the difference was statistically significant (P < 0.001). Except in emergency circumstances, surgery in Child class C patients may either be delayed until the patient is medically optimized or performed early before liver disease progresses to severe decompensation.
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Affiliation(s)
- Muhammad Rizwan Khan
- Aga Khan University & Hospital, Department of Surgery, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
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20
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"Tension-free" herniorrhaphy for groin hernias in patients with cirrhosis: report of four cases. Surg Today 2009; 39:540-3. [PMID: 19468814 DOI: 10.1007/s00595-008-3872-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/19/2008] [Indexed: 01/13/2023]
Abstract
Tension-free herniorraphies were carried out using either the Mesh Plug repair (M-P) or Perfix plug technique (P-P) in four patients with cirrhosis. Three patients had a lateral inguinal hernia, and the other had bilateral inguinal and femoral hernias. The patients' ages ranged from 55 to 80 years. The Child-Pugh classifications showed that one was A, two were B, and one was C. The main complaint in two patients was a difficult reduction and the others had discomfort. An M-P was performed in the three patients with inguinal hernias and an M-P was performed for the femoral hernias and a P-P for the inguinal hernias in the patient with both inguinal and femoral hernias. Two patients had fluid collection under the incision and one of them required a single puncture. However, the others had no related complications after the operation. One patient died due to liver failure without recurrence of the groin hernias 31 months after the operation. The others had no recurrence and no related symptoms from 5 to 52 months after the operation.
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Frye JW, Perri RE. Perioperative risk assessment for patients with cirrhosis and liver disease. Expert Rev Gastroenterol Hepatol 2009; 3:65-75. [PMID: 19210114 DOI: 10.1586/17474124.3.1.65] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with cirrhosis are at an increased risk of complications of operative procedures. There is a growing understanding of the nature of the risks that cirrhotic patients experience, as well as more precise and objective tools to gauge the patients at risk for surgical complications. Surgical procedures that are common and high risk for patients with cirrhosis are cardiac surgery, cholecystectomy and hepatic resections, as well as other abdominal surgeries and orthopedic surgeries. The physicians who care for patients with cirrhosis who require a surgical procedure can apply an understanding of the type of surgery anticipated with knowledge of the severity of the patient's liver disease to predict those patients at risk for operative morbidity and mortality. A sound knowledge of the specific operative risks faced by patients with cirrhosis should prompt the clinician to take steps to prevent these complications.
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Affiliation(s)
- Jeanetta W Frye
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Inguinal hernioplasty improves the quality of life in patients with cirrhosis. Am J Surg 2008; 196:373-8. [PMID: 18639226 DOI: 10.1016/j.amjsurg.2008.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 02/28/2008] [Accepted: 02/28/2008] [Indexed: 12/24/2022]
Abstract
BACKGROUND The optimal management of symptomatic inguinal hernia (SIH) in cirrhotics is still undefined. Both hernia and cirrhosis impair quality of life (QOL). The aim of this study was to evaluate QOL by a Short Form-36 (SF-36) questionnaire in cirrhotic patients undergoing inguinal hernioplasty. METHODS Thirty-two cirrhotic patients undergoing inguinal hernioplasty were evaluated. They were classified according to Child's class and to the absence or presence of refractory ascites. The SF-36 questionnaire was administered the day before and 6 months after surgery. Global analyses of the 8 domains of SF-36 and of 2 comprehensive indexes of SF-36, Physical Component Summary (PCS) and Mental Component Summary (MCS), were performed. RESULTS Lichtenstein hernioplasty for SIH originated no major complications. All 8 domains of SF-36 and MCS and PCS scores improved remarkably after hernioplasty especially in patients in Child's class C and/or with refractory ascites. CONCLUSIONS Inguinal hernioplasty for SIH in patients with cirrhosis is a safe procedure. The improvement of QOL represents a clear cut indication for elective hernia repair.
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