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Umbilical hernia repair in patients with cirrhosis: who, when and how to treat

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Abstract

Purpose

Hernia management in patients with cirrhosis is a challenging problem, where indication, timing and type of surgery have been a subject of debate. Given the high risk of morbidity and mortality following surgery, together with increased risk of recurrence, a wait and see approach was often advocated in the past.

Methods

The purpose of this review was to provide an overview of crucial elements in the treatment of patients with cirrhosis and umbilical hernia.

Results

Perioperative ascites control is regarded as the major factor in timing of hernia repair and is considered the most important factor governing outcome. This can be accomplished by either medical treatment, ascites drainage prior to surgery or reduction of portal hypertension by means of a transjugular intrahepatic portosystemic shunt (TIPS). The high incidence of perioperative complications and inferior outcomes of emergency surgery strongly favor elective surgery, instead of a “wait and see” approach, allowing for adequate patient selection, scheduled timing of elective surgery and dedicated perioperative care. The Child–Pugh–Turcotte and MELD score remain strong prognostic parameters and furthermore aid in identifying patients who fulfill criteria for liver transplantation. Such patients should be evaluated for early listing as potential candidates for transplantation and simultaneous hernia repair, especially in case of umbilical vein recanalization and uncontrolled refractory preoperative ascites. Considering surgical techniques, low-quality evidence suggests mesh implantation might reduce hernia recurrence without dramatically increasing morbidity, at least in elective circumstances.

Conclusion

Preventing emergency surgery and optimizing perioperative care are crucial factors in reducing morbidity and mortality in patients with umbilical hernia and cirrhosis.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    M. Bronswijk, M. Struyve & S. van der Merwe

  2. Department of Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium

    M. Bronswijk

  3. Imelda GI Clinical Research Center, Bonheiden, Belgium

    M. Bronswijk

  4. Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    J. Jaekers & M. Miserez

  5. Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy

    G. Vanella

  6. Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium

    M. Struyve

  7. Laboratory of Hepatology, CHROMETA Department, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    S. van der Merwe

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  1. M. Bronswijk
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  2. J. Jaekers
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  3. G. Vanella
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Contributions

MB and JJ wrote the manuscript and performed the literature review, with support from GV and MS. MM and SVDM critically reviewed the final versions of the manuscript.

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Correspondence to S. van der Merwe.

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Bronswijk, M., Jaekers, J., Vanella, G. et al. Umbilical hernia repair in patients with cirrhosis: who, when and how to treat. Hernia 26, 1447–1457 (2022). https://doi.org/10.1007/s10029-022-02617-7

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