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ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 2  |  Page : 538-543

Elective and emergency repair of umbilical hernia in cirrhotic patients with ascites


1 Department of General Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt
2 Department of Internal Medicine, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt

Correspondence Address:
MD Radwa M Attia
MD Degree of General Surgery, Lecturer of General Surgery, Department of General Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjamf.sjamf_43_19

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Background Umbilical hernia is a common finding in cirrhotic patients with ascites. The incidence of umbilical hernia is 20–40% in cirrhotic patients, and emergency repair is indicated in critical cases if there is ascites leakage, irreducibility, and infection, with high rate of morbidity and mortality than elective cases. Aim To evaluate the effectiveness of elective hernioplasty rather than emergent one. Patients and methods A total of 50 patients were included in this study between December 2017 and December 2018 at Al Zahraa University Hospital. They were divided into two groups: (a) elective group included 25 patients with moderate to severe ascites, and (b) emergent group included 25 patients with moderate to severe ascites, of them 10 (40%) cases presented with spontaneous eruption of umbilical hernia, whereas 15 (60%) patients presented with irreducible umbilical hernia. There were 30 (60%) males and 20 (40%) females. Their age ranged between 40 and 65 years, with an average age of 45 years. Umbilical hernioplasty was done for all patients in both groups by using polypropylene mesh after preparation. Results In this study, one operative procedure was done for all patients. Using polypropylene mesh with peritoneal dialysis, a catheter was placed in all cases of both groups. There is difference between elective and emergency groups in operative time, postoperative hospital stay, and also early postoperative complication. Long-term follow-up was done in both groups and revealed death owing to liver failure as a complication of cirrhosis in three (12%) patients in the emergent group and in only one (4%) patient in the elective group. Conclusion Higher morbidity and mortality are associated with the emergency surgery in advanced cirrhotic patients. The prognosis is favorable for patients with good hepatic reserve.


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