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Umbilical hernia repair in patients with cirrhosis: systematic review of mortality and complications

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Abstract

Background

Umbilical hernia is a common and potential serious condition in patients with cirrhosis. This systematic review evaluated the risks associated with emergency and elective hernia repair in patients with cirrhosis.

Methods

Systematic review of clinical trials identified through manual and electronic searches in several databases (last update November 2021). The primary random-effects meta-analyses evaluated mortality in patients with or without cirrhosis or following emergency versus elective repair. The quality of the evidence was assessed using GRADE and Newcastle Ottawa Scale.

Results

Thirteen prospective and 10 retrospective studies including a total of 3229 patients were included. The evidence was graded as very low quality for all outcomes (mortality and postoperative complications within 90 days). In total 191 patients (6%) died after undergoing umbilical hernia repair. Patients with cirrhosis were more than eight times as likely to die after surgery compared with patients without cirrhosis [OR = 8.50, 95% CI (1.91–37.86)] corresponding to 69 more deaths/1000 patients. Among patients with cirrhosis, mortality was higher after emergency versus elective repair [OR = 2.67, 95% CI (1.87–3.97)] corresponding to 52 more deaths/1000 patients. Postoperative complications were more common in patients with cirrhosis compared with patients without cirrhosis.

Conclusion

Patients with cirrhosis undergoing emergency umbilical hernia repair have a considerably increased risk of death and severe complications. Accordingly, additional evidence is needed to evaluate methods that would allow elective umbilical hernia repair in patients with cirrhosis.

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This work did not receive any funding.

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Authors and Affiliations

  1. Gastro Unit, Hvidovre Hospital, University of Copenhagen, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark

    C. Snitkjær, M. P. Werge, N. Kimer, L. L. Gluud & M. W. Christoffersen

  2. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark

    K. K. Jensen

  3. Abdominal Center, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark

    N. A. Henriksen

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  1. C. Snitkjær
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  2. K. K. Jensen
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  3. N. A. Henriksen
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  4. M. P. Werge
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Snitkjær, C., Jensen, K.K., Henriksen, N.A. et al. Umbilical hernia repair in patients with cirrhosis: systematic review of mortality and complications. Hernia 26, 1435–1445 (2022). https://doi.org/10.1007/s10029-022-02598-7

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