Umbilical hernia repair in cirrhotic patients: utility of temporary peritoneal dialysis catheter

Umbilical herniorrhaphy in cirrhotic patients with ascites is associated with a significant morbidity, recurrence rate, and mortality and therefore is often managed expectantly. Operative repair is indicated if an ascites leak or infection develops. Surgeons must consider the management of postopera...

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Bibliographic Details
Published in:The American surgeon 2005-01, Vol.71 (1), p.58-61
Main Authors: Slakey, Douglas P, Benz, Cynthia C, Joshi, Shobha, Regenstein, Fredric G, Florman, Sander S
Format: Article
Language:English
Subjects:
Adult
Aged
Ascites - etiology
Ascites - therapy
Catheterization
Catheters
Follow-Up Studies
Hemodialysis
Hernia, Umbilical - complications
Hernia, Umbilical - surgery
Humans
Infections
Liver cirrhosis
Liver Cirrhosis - complications
Liver Cirrhosis - surgery
Middle Aged
Morbidity
Paracentesis - instrumentation
Patients
Peritoneal Dialysis - methods
Postoperative Care - instrumentation
Postoperative Complications - mortality
Recurrence
Surgery
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Summary:Umbilical herniorrhaphy in cirrhotic patients with ascites is associated with a significant morbidity, recurrence rate, and mortality and therefore is often managed expectantly. Operative repair is indicated if an ascites leak or infection develops. Surgeons must consider the management of postoperative ascites to reduce recurrence rates and complications. We present a unique method using temporary peritoneal dialysis catheter placement (PD). Eight patients with moderate to massive ascites underwent umbilical herniorrhaphy with concomitant peritoneal dialysis placement. Patients have been followed for 8 to 30 months. All patients had successful repair of their hernia with 1 recurrence at 6 months and 1 late death (14 months). Patients were able to effectively control ascites using the PD catheter at home. There were no postoperative infections. The placement of a temporary PD catheter during umbilical herniorrhaphy provides a method for effective control of ascites in patients with cirrhosis. The technique has several advantages including outpatient management during the postoperative period and for easy removal of the catheter when no longer needed.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313480507100111