Abdominal wall hernias surgery in patients with cirrhosis and ascites

Abstract

Background: Management of abdominal wall hernias in patients with liver cirrhosis with massive resistance ascites is still under debate. The objective of this study was to compare the outcome in our series of urgently versus scheduled operated treatment of these patients. Methods. In the period between 2011 and 2015, 102 patients with an abdominal wall hernias combined with liver cirrhosis and ascites were identified from our hospital database. I group: 48 cirrhotic patients operated on urgently, including 36 (75%) - with hernia sac erupts with ascites fluid overflow and 12 (25%) with strangulated hernias. 9 (18.8%) patients was performed endoscopic hemostasis simultaneously for variceal bleeding. In 85% cases ascites fluid was present bacterial microflora. In all cases was installed abdominal drainage, for drainage ascites and lavage abdominal cavity. Group II: 54 cirrhotic patients with massive ascites and spontaneous eruption risk of hernia, operated scheduled after a thorough preoperative preparation, laparoscopic drainage of abdominal ascites and abdominal cavity lavage with antibacterials. In 55% cases ascites fluid was present bacterial microflora. Plasty method - "tension-free no mesh". Prophylactic endoscopic variceal sealing was performed in 29 (53.7%) patients.Results. 7 patients from the first group died postoperatively with hepatic insufficiency (14.6%), including 4 with variceal bleeding and 3 ascites-peritonitis. In group II was 1 (1.9%) death - hepatorenal failure. Postoperative eventration 3-6 months: I group - 10 (20,8%); II group - 2 (3.7%). Suppuration of postoperative wound: I group - 8 (16.7%), II group without complications. Conclusions. Abdominal wall hernias in cirrhotic patients with ascites preferable operated planned. Laparoscopic abdominal drainage and lavage with antibacterials reduces the risk of ascitesperitonitis, improves wound healing. The preferably solution is hernioplasty "tension-free no mesh".