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Prognosis of surgical hernia repair in cirrhotic patients with refractory ascites

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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Acknowledgements

This study was supported by Grants from the Daewoong (nos. 800-20150450 and 800-20150451).

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Correspondence to Y. J. Kim.

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None of the authors have any conflict of interest.

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This study was approved by the Institutional Review Board of the Seoul National University Hospital (IRB No.: 1801-981-980).

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This study does not contain any studies with animals performed by any of the authors.

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Kim, S.W., Kim, M.A., Chang, Y. et al. Prognosis of surgical hernia repair in cirrhotic patients with refractory ascites. Hernia 24, 481–488 (2020). https://doi.org/10.1007/s10029-019-02043-2

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Keywords

  • Hernia repair
  • Liver cirrhosis
  • Refractory ascites