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Safety and effectiveness of umbilical hernia repair in patients with cirrhosis
Purpose Umbilical hernia is a common complication in patients with cirrhosis. Early studies have reported a high morbidity and mortality associated with hernia repair. The traditional approach has been to non-operatively manage umbilical hernias in patients with cirrhosis. There are emerging data su...
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| Published in: | Hernia : the journal of hernias and abdominal wall surgery 2018-10, Vol.22 (5), p.759-765 |
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| container_end_page | 765 |
| container_issue | 5 |
| container_start_page | 759 |
| container_title | Hernia : the journal of hernias and abdominal wall surgery |
| container_volume | 22 |
| creator | Hew, S. Yu, W. Robson, S. Starkey, G. Testro, A. Fink, M. Angus, P. Gow, P. |
| description | Purpose
Umbilical hernia is a common complication in patients with cirrhosis. Early studies have reported a high morbidity and mortality associated with hernia repair. The traditional approach has been to non-operatively manage umbilical hernias in patients with cirrhosis. There are emerging data suggesting that an elective repair is a preferable approach. This study examined the outcomes of umbilical hernia repair in patients with advanced liver disease and compared this with a control group of non-cirrhotic patients.
Methods
Prospective data were collected regarding the outcome of umbilical hernia repairs performed between 2004 and 2013 at the Austin Hospital, Melbourne, Australia. Outcomes at 90 days were compared between patients with and without cirrhosis.
Results
79 patients with cirrhosis and 249 controls were analysed. Of the patients with cirrhosis, 9% were classified as Child–Pugh A, 61% were Child–Pugh B and 30% were Child–Pugh C. Emergency repairs for complicated hernias was undertaken in 18% of the cirrhosis population and 10% in controls (
P
= 0.10). Post-operative complications occurred more commonly in patients with cirrhosis (26%) compared with controls (11%) (
P
|
| doi_str_mv | 10.1007/s10029-018-1761-9 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2019470074</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2019064361</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-afa0d83821fc35f34ae71b518ff749e2e381212aac6dc12da9d890b8f1cbf763</originalsourceid><addsrcrecordid>eNp1kE1LxDAURYMofoz-ADcScOOmmpembbKUwS8YdKH7kKYvTqTTjkmr-O_NOKOC4CYJ5Nz7HoeQY2DnwFh1EdPJVcZAZlCVkKktsg9cyExxJrZX77LIhGLlHjmI8YUxJkUpd8keV4VUkBf75P7ROBw-qOkais6hHfwbdhgj7R0dF7VvvTUtnWPovKEBl8YH6ju6NIPHboj03Q9zan0I8z76eEh2nGkjHm3uCXm6vnqa3mazh5u76eUss3nFh8w4wxqZSw7O5oXLhcEK6gKkc5VQyDGXwIEbY8vGAm-MaqRitXRga1eV-YScrWuXoX8dMQ564aPFtjUd9mPUnIESVVIkEnr6B33px9Cl5b4oVoq8hETBmrKhjzGg08vgFyZ8aGB65VqvXevkWq9ca5UyJ5vmsV5g85P4lpsAvgZi-uqeMfyO_r_1E-rUiZA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2019064361</pqid></control><display><type>article</type><title>Safety and effectiveness of umbilical hernia repair in patients with cirrhosis</title><source>Springer Link</source><creator>Hew, S. ; Yu, W. ; Robson, S. ; Starkey, G. ; Testro, A. ; Fink, M. ; Angus, P. ; Gow, P.</creator><creatorcontrib>Hew, S. ; Yu, W. ; Robson, S. ; Starkey, G. ; Testro, A. ; Fink, M. ; Angus, P. ; Gow, P.</creatorcontrib><description>Purpose
Umbilical hernia is a common complication in patients with cirrhosis. Early studies have reported a high morbidity and mortality associated with hernia repair. The traditional approach has been to non-operatively manage umbilical hernias in patients with cirrhosis. There are emerging data suggesting that an elective repair is a preferable approach. This study examined the outcomes of umbilical hernia repair in patients with advanced liver disease and compared this with a control group of non-cirrhotic patients.
Methods
Prospective data were collected regarding the outcome of umbilical hernia repairs performed between 2004 and 2013 at the Austin Hospital, Melbourne, Australia. Outcomes at 90 days were compared between patients with and without cirrhosis.
Results
79 patients with cirrhosis and 249 controls were analysed. Of the patients with cirrhosis, 9% were classified as Child–Pugh A, 61% were Child–Pugh B and 30% were Child–Pugh C. Emergency repairs for complicated hernias was undertaken in 18% of the cirrhosis population and 10% in controls (
P
= 0.10). Post-operative complications occurred more commonly in patients with cirrhosis (26%) compared with controls (11%) (
P
< 0.01). Emergency hernia repairs were associated with a higher complication rate in both patients with cirrhosis (62%) and controls (20%) (
P
= 0.01). There was no significant difference in the rate of hernia recurrence as assessed by clinical examination between patients with cirrhosis (2.7%) and controls (6.8%) (
P
= 0.17) nor in 90-day mortality between patients with cirrhosis (
n
= 1, 1.3%) and the controls (
n
= 0) (
P
= 0.43).
Conclusions
Within the limitations of a small study cohort and therefore an underpowered study, elective surgical repair of umbilical hernias in patients with cirrhosis, including decompensated cirrhosis, may not be associated with a significant increase in mortality when compared to a control cohort. Whilst complications are higher in cirrhotic patients, there is no difference in the rate of hernia recurrence. Emergency repairs of umbilical hernias are associated with a high complication rate in cirrhotic patients.</description><identifier>ISSN: 1265-4906</identifier><identifier>EISSN: 1248-9204</identifier><identifier>DOI: 10.1007/s10029-018-1761-9</identifier><identifier>PMID: 29589135</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cirrhosis ; Elective Surgical Procedures ; Emergencies ; Female ; Hernia ; Hernia, Umbilical - complications ; Hernia, Umbilical - surgery ; Hernias ; Humans ; Length of Stay - statistics & numerical data ; Liver cirrhosis ; Liver Cirrhosis - complications ; Liver diseases ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Morbidity ; Mortality ; Original Article ; Postoperative Complications ; Prospective Studies ; Surgical Mesh</subject><ispartof>Hernia : the journal of hernias and abdominal wall surgery, 2018-10, Vol.22 (5), p.759-765</ispartof><rights>Springer-Verlag France SAS, part of Springer Nature 2018</rights><rights>Hernia is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-afa0d83821fc35f34ae71b518ff749e2e381212aac6dc12da9d890b8f1cbf763</citedby><cites>FETCH-LOGICAL-c372t-afa0d83821fc35f34ae71b518ff749e2e381212aac6dc12da9d890b8f1cbf763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29589135$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hew, S.</creatorcontrib><creatorcontrib>Yu, W.</creatorcontrib><creatorcontrib>Robson, S.</creatorcontrib><creatorcontrib>Starkey, G.</creatorcontrib><creatorcontrib>Testro, A.</creatorcontrib><creatorcontrib>Fink, M.</creatorcontrib><creatorcontrib>Angus, P.</creatorcontrib><creatorcontrib>Gow, P.</creatorcontrib><title>Safety and effectiveness of umbilical hernia repair in patients with cirrhosis</title><title>Hernia : the journal of hernias and abdominal wall surgery</title><addtitle>Hernia</addtitle><addtitle>Hernia</addtitle><description>Purpose
Umbilical hernia is a common complication in patients with cirrhosis. Early studies have reported a high morbidity and mortality associated with hernia repair. The traditional approach has been to non-operatively manage umbilical hernias in patients with cirrhosis. There are emerging data suggesting that an elective repair is a preferable approach. This study examined the outcomes of umbilical hernia repair in patients with advanced liver disease and compared this with a control group of non-cirrhotic patients.
Methods
Prospective data were collected regarding the outcome of umbilical hernia repairs performed between 2004 and 2013 at the Austin Hospital, Melbourne, Australia. Outcomes at 90 days were compared between patients with and without cirrhosis.
Results
79 patients with cirrhosis and 249 controls were analysed. Of the patients with cirrhosis, 9% were classified as Child–Pugh A, 61% were Child–Pugh B and 30% were Child–Pugh C. Emergency repairs for complicated hernias was undertaken in 18% of the cirrhosis population and 10% in controls (
P
= 0.10). Post-operative complications occurred more commonly in patients with cirrhosis (26%) compared with controls (11%) (
P
< 0.01). Emergency hernia repairs were associated with a higher complication rate in both patients with cirrhosis (62%) and controls (20%) (
P
= 0.01). There was no significant difference in the rate of hernia recurrence as assessed by clinical examination between patients with cirrhosis (2.7%) and controls (6.8%) (
P
= 0.17) nor in 90-day mortality between patients with cirrhosis (
n
= 1, 1.3%) and the controls (
n
= 0) (
P
= 0.43).
Conclusions
Within the limitations of a small study cohort and therefore an underpowered study, elective surgical repair of umbilical hernias in patients with cirrhosis, including decompensated cirrhosis, may not be associated with a significant increase in mortality when compared to a control cohort. Whilst complications are higher in cirrhotic patients, there is no difference in the rate of hernia recurrence. Emergency repairs of umbilical hernias are associated with a high complication rate in cirrhotic patients.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Case-Control Studies</subject><subject>Cirrhosis</subject><subject>Elective Surgical Procedures</subject><subject>Emergencies</subject><subject>Female</subject><subject>Hernia</subject><subject>Hernia, Umbilical - complications</subject><subject>Hernia, Umbilical - surgery</subject><subject>Hernias</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver diseases</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Original Article</subject><subject>Postoperative Complications</subject><subject>Prospective Studies</subject><subject>Surgical Mesh</subject><issn>1265-4906</issn><issn>1248-9204</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kE1LxDAURYMofoz-ADcScOOmmpembbKUwS8YdKH7kKYvTqTTjkmr-O_NOKOC4CYJ5Nz7HoeQY2DnwFh1EdPJVcZAZlCVkKktsg9cyExxJrZX77LIhGLlHjmI8YUxJkUpd8keV4VUkBf75P7ROBw-qOkais6hHfwbdhgj7R0dF7VvvTUtnWPovKEBl8YH6ju6NIPHboj03Q9zan0I8z76eEh2nGkjHm3uCXm6vnqa3mazh5u76eUss3nFh8w4wxqZSw7O5oXLhcEK6gKkc5VQyDGXwIEbY8vGAm-MaqRitXRga1eV-YScrWuXoX8dMQ564aPFtjUd9mPUnIESVVIkEnr6B33px9Cl5b4oVoq8hETBmrKhjzGg08vgFyZ8aGB65VqvXevkWq9ca5UyJ5vmsV5g85P4lpsAvgZi-uqeMfyO_r_1E-rUiZA</recordid><startdate>20181001</startdate><enddate>20181001</enddate><creator>Hew, S.</creator><creator>Yu, W.</creator><creator>Robson, S.</creator><creator>Starkey, G.</creator><creator>Testro, A.</creator><creator>Fink, M.</creator><creator>Angus, P.</creator><creator>Gow, P.</creator><general>Springer Paris</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20181001</creationdate><title>Safety and effectiveness of umbilical hernia repair in patients with cirrhosis</title><author>Hew, S. ; Yu, W. ; Robson, S. ; Starkey, G. ; Testro, A. ; Fink, M. ; Angus, P. ; Gow, P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-afa0d83821fc35f34ae71b518ff749e2e381212aac6dc12da9d890b8f1cbf763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Case-Control Studies</topic><topic>Cirrhosis</topic><topic>Elective Surgical Procedures</topic><topic>Emergencies</topic><topic>Female</topic><topic>Hernia</topic><topic>Hernia, Umbilical - complications</topic><topic>Hernia, Umbilical - surgery</topic><topic>Hernias</topic><topic>Humans</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver diseases</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Original Article</topic><topic>Postoperative Complications</topic><topic>Prospective Studies</topic><topic>Surgical Mesh</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hew, S.</creatorcontrib><creatorcontrib>Yu, W.</creatorcontrib><creatorcontrib>Robson, S.</creatorcontrib><creatorcontrib>Starkey, G.</creatorcontrib><creatorcontrib>Testro, A.</creatorcontrib><creatorcontrib>Fink, M.</creatorcontrib><creatorcontrib>Angus, P.</creatorcontrib><creatorcontrib>Gow, P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Hernia : the journal of hernias and abdominal wall surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hew, S.</au><au>Yu, W.</au><au>Robson, S.</au><au>Starkey, G.</au><au>Testro, A.</au><au>Fink, M.</au><au>Angus, P.</au><au>Gow, P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and effectiveness of umbilical hernia repair in patients with cirrhosis</atitle><jtitle>Hernia : the journal of hernias and abdominal wall surgery</jtitle><stitle>Hernia</stitle><addtitle>Hernia</addtitle><date>2018-10-01</date><risdate>2018</risdate><volume>22</volume><issue>5</issue><spage>759</spage><epage>765</epage><pages>759-765</pages><issn>1265-4906</issn><eissn>1248-9204</eissn><abstract>Purpose
Umbilical hernia is a common complication in patients with cirrhosis. Early studies have reported a high morbidity and mortality associated with hernia repair. The traditional approach has been to non-operatively manage umbilical hernias in patients with cirrhosis. There are emerging data suggesting that an elective repair is a preferable approach. This study examined the outcomes of umbilical hernia repair in patients with advanced liver disease and compared this with a control group of non-cirrhotic patients.
Methods
Prospective data were collected regarding the outcome of umbilical hernia repairs performed between 2004 and 2013 at the Austin Hospital, Melbourne, Australia. Outcomes at 90 days were compared between patients with and without cirrhosis.
Results
79 patients with cirrhosis and 249 controls were analysed. Of the patients with cirrhosis, 9% were classified as Child–Pugh A, 61% were Child–Pugh B and 30% were Child–Pugh C. Emergency repairs for complicated hernias was undertaken in 18% of the cirrhosis population and 10% in controls (
P
= 0.10). Post-operative complications occurred more commonly in patients with cirrhosis (26%) compared with controls (11%) (
P
< 0.01). Emergency hernia repairs were associated with a higher complication rate in both patients with cirrhosis (62%) and controls (20%) (
P
= 0.01). There was no significant difference in the rate of hernia recurrence as assessed by clinical examination between patients with cirrhosis (2.7%) and controls (6.8%) (
P
= 0.17) nor in 90-day mortality between patients with cirrhosis (
n
= 1, 1.3%) and the controls (
n
= 0) (
P
= 0.43).
Conclusions
Within the limitations of a small study cohort and therefore an underpowered study, elective surgical repair of umbilical hernias in patients with cirrhosis, including decompensated cirrhosis, may not be associated with a significant increase in mortality when compared to a control cohort. Whilst complications are higher in cirrhotic patients, there is no difference in the rate of hernia recurrence. Emergency repairs of umbilical hernias are associated with a high complication rate in cirrhotic patients.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>29589135</pmid><doi>10.1007/s10029-018-1761-9</doi><tpages>7</tpages></addata></record> |
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| ispartof | Hernia : the journal of hernias and abdominal wall surgery, 2018-10, Vol.22 (5), p.759-765 |
| issn | 1265-4906 1248-9204 |
| language | eng |
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| source | Springer Link |
| subjects | Abdominal Surgery Adult Aged Aged, 80 and over Case-Control Studies Cirrhosis Elective Surgical Procedures Emergencies Female Hernia Hernia, Umbilical - complications Hernia, Umbilical - surgery Hernias Humans Length of Stay - statistics & numerical data Liver cirrhosis Liver Cirrhosis - complications Liver diseases Male Medicine Medicine & Public Health Middle Aged Morbidity Mortality Original Article Postoperative Complications Prospective Studies Surgical Mesh |
| title | Safety and effectiveness of umbilical hernia repair in patients with cirrhosis |
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