Hernia Repair in Cirrhotic Patients: Type, Timing, and Procedure of Choice



Abdominal and groin hernias are common in the presence of ascites and cirrhosis in patients with chronic liver disease. This patient population carries an inherently higher surgical risk than that of the general population. Nevertheless, their hernias are often symptomatic and carry a higher risk of incarceration and strangulation. For these reasons, the previously proposed “watch and wait approach” management strategy for this population is no longer acceptable. Herein, we detail the pathophysiology of abdominal and groin hernia development in this patient population as well as our surgical approach to these patients.


Chronic liver disease Cirrhosis End-stage liver disease Hernia Inguinal hernia Ventral hernia 


  1. 1.
    Lim YS, Kim R. The global impact of hepatic fibrosis and end-stage liver disease. Clin Liver Dis. 2008;12(4):733–46.CrossRefPubMedGoogle Scholar
  2. 2.
    Kim WR, Brown RS, Terrault NA, et al. Burden of liver disease in the United States: summary of a workshop. Hepatology. 2002;36:227–42.CrossRefPubMedGoogle Scholar
  3. 3.
    Falagas ME, Vardakas KZ, Vergidis PI. Under-diagnosis of common chronic diseases prevalence and impact on human health. Int J Clin Pract. 2007;61:1569–79.CrossRefPubMedGoogle Scholar
  4. 4.
    Friedman SL. Liver fibrosis-from bench to bedside. J Hepatol. 2003;38:S38–53.CrossRefPubMedGoogle Scholar
  5. 5.
    Park JK, Lee SH, Yoon WJ, et al. Evaluation of hernia repair operations in Child-Turcotte-Pugh class C cirrhosis and refractory ascites. J Gastroenterol Hepatol. 2007;22(3):377–82.CrossRefPubMedGoogle Scholar
  6. 6.
    McKay A, Dixon E, Bathe O, et al. Umbilical hernia repair in the presence of cirrhosis and ascites: results of a surgery and review of the literature. Hernia. 2009;13:461–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Andraus W, Pinheiro RS, Lai Q, et al. Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality. BMC Surg. 2015;15:65–71.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Marsman HA, Heisterkamp J, Halm JA, et al. Management in patients with liver cirrhosis and an umbilical hernia. Surgery. 2007;142(3):372–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Eker HH, van Ramshorst GH, de Goede B, et al. A prospective study on elective umbilical hernia repair in patients with liver cirrhosis and ascites. Surgery. 2011;150(3):542–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Carbonell AM, Wolge LG, DeMaria EJ. Poor outcomes in cirrhosis-associated hernia repair: a nationwide cohort study of 32,033 patients. Hernia. 2005;9:353–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Hur YH, Kim JC, Kim SK, et al. Inguinal hernia repair in patients with liver cirrhosis accompanied by ascites. J Korean Surg Soc. 2011;80(6):420–5.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Sola E, Gines P. Renal and circulatory dysfunction in cirrhosis: current management and future perspectives. J Hepatol. 2010;53(6):1135–45.CrossRefPubMedGoogle Scholar
  13. 13.
    Such J, Runyon BA. Pathogenesis of ascites in patients with cirrhosis. In: UpToDate, Lindor KD, editor, Waltham. Accessed 5 May 2016.Google Scholar
  14. 14.
    Anthony T, Bergen PC, Kim LT, et al. Factors affecting recurrence following incisional herniorrhaphy. World J Surg. 2000;24:95–101.CrossRefPubMedGoogle Scholar
  15. 15.
    Froylich D, Segal M, Weinstein A, et al. Laparoscopic versus open ventral hernia repair in obese patients: a long-term follow-up. Surg Endosc. 2016;30(2):670–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Rosen MJ, Aydogdu K, Grafmiller K, et al. A multidisciplinary approach to medical weight loss prior to complex abdominal wall reconstruction: is it feasible? J Gastrointest Surg. 2015;19(8):1399–406.CrossRefPubMedGoogle Scholar
  17. 17.
    Velkovic R, Protic M, Gluhovic A, et al. Prospective clinical trial of factors predicting the early development of incisional hernia after midline laparotomy. J Am Coll Surg. 2010;210(2):210–9.CrossRefGoogle Scholar
  18. 18.
    Singal AK, Kamath PS. Model for end-stage liver disease. J Clin Exp Hepatol. 2013;3(1):50–60.CrossRefPubMedGoogle Scholar
  19. 19.
    Hurst RD, Butker BN, Soybel DI, et al. Management of groin hernias in patients with ascites. Ann Surg. 1992;216(6):696–700.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Fagan SP, Awad AA, Berger DH. Management of complicated umbilical hernias in patients with end-stage liver disease and refractory ascites. Surgery. 2004;135(6):679–82.CrossRefPubMedGoogle Scholar
  21. 21.
    Krpata DM, Blatnik JA, Novitsky YW, et al. Posterior and open anterior components separations: a comparative analysis. Am J Surg. 2012;203(3):318–22.CrossRefPubMedGoogle Scholar
  22. 22.
    Novitsky YW, Elliott HL, Orenstein SB, et al. Transversus abdominis muscle release: a novel approach to posterior component separation during abdominal wall reconstruction. Am J Surg. 2012;204(5):709–16.CrossRefPubMedGoogle Scholar
  23. 23.
    Ammar SA. Management of complicated hernias in cirrhotic patients using permanent mesh: randomized clinical trial. Hernia. 2010;14(1):35–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Rosen MJ, Krpata DM, Ermlich B, et al. A 5-year clinical experience with single-staged repairs of infection and contaminated abdominal wall defects utilizing biologic mesh. Ann Surg. 2013;257(6):991–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Comprehensive Hernia CenterDigestive Disease and Surgery InstituteClevelandUSA

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