Hernia repair in patients with chronic liver disease - A 15-year single-center experience

Abstract

BackgroundElective hernia repairs in chronic liver disease (CLD) patients are often avoided due to the fear of hepatic decompensation and mortality, leaving the patient susceptible to an emergent presentation. MethodsCLD patients undergoing ventral or inguinal hernia repair in emergent and non-emergent settings at our institution (2001–2015) were analyzed. Predictors of 30-day morbidity and mortality (M&M) were determined using univariate analysis and multivariate logistic regression. ResultsA total of 186 non-emergent repairs identified acceptable rates of M&M (27%) and 90-day mortality (3.7%, 0/21 for MELD≥15). Meanwhile, 67 emergent repairs had higher rates of M&M (60%) and 90-day mortality (10%; 25% for MELD≥15). M&M was associated with elevated MELD scores in emergent cases (14 ± 6 vs 11 ± 4; p = 0.01) and intraoperative drain placement in non-emergent cases (OR1.31,p < 0.01). ConclusionIn patients with advanced CLD, non-emergent hernia repairs carry acceptable rates of M&M, while emergent repairs have increased M&M rates associated with higher MELD scores.