Abstract
Ascites is the most common complication in patients with liver cirrhosis. Umbilical hernias (HU) occur in 20% of these patients and 40% in those with severe ascites. HU occurs due to increased intra-abdominal pressure, weakening of the abdominal fascia and loss of muscle mass. In addition, they have a tendency to enlarge rapidly and present high risk of complications that threaten the patient’s life. The treatment of the uncomplicated HU is controversial, both the surgical management (herniorrhaphy) and the conservative management (control of ascites) present high rate of complications, consequently high morbidity and mortality. Currently, umbilical herniorrhaphy is recommended with prior control of ascites in uncomplicated HU management, it reduces the risk of surgical wound infection, evisceration, ascites drainage, peritonitis, and it reduces up to 41% of HU recurrence. The success of this approach also depends on the degree of liver dysfunction. The treatment of complicated HU is surgical (herniorrhaphy without mesh), with lower mortality rate compared to conservative management. Studies reveal advantages of umbilical herniorrhaphy laparoscopy (minimally invasive and stress-free) compared to open surgery; however there is still no evidence about it.
Highlights
Ascites is the most common complication in patients with liver cirrhosis
Actualmente, se recomienda herniorrafia umbilical con previo control de la ascitis en el manejo de hernias umbilicales (HU) no complicada, reduce el riesgo de infección de herida operatoria, evisceración, drenaje de ascitis, peritonitis y reduce hasta 41% la recidiva de HU
Ya que el control eficaz de la ascitis reduce el riesgo de infección de herida operatoria, evisceración, drenaje de la ascitis, peritonitis y reduce hasta en 41% de recidiva de la hernia umbilical
Summary
Consiste en herniorrafia umbilical con malla de manera electiva, es seguro, eficaz y reduce la recurrencia de hernia, además ha demostrado ser superior a la herniorrafia sola en las reparaciones electivas. La morbilidad en pacientes cirróticos, con ascitis y hernia umbilical complicada es elevada, pudiendo ser la postoperatoria de hasta 71%; mientras que el riesgo de mortalidad puede variar entre 60-80% tras el tratamiento conservador y de 6-20% tras la reparación quirúrgica de urgencia[2,8]. Se puede plantear que en pacientes cirróticos con ascitis y HU complicada, el manejo debe realizarse con urgencia[2,3]. La resolución de la patología herniaria complicada en estos pacientes en caso sea posible, debe realizarse sin prótesis (para disminuir el riesgo de infección) e idealmente con la técnica de Mayo (con o sin resección de ombligo) con sutura secundaria de flap (con sutura irreabsorbible, preferentemente polipropileno 0 y 2-0). Estudios disponibles sobre el manejo hernia umbilical no complicada en pacientes cirróticos con ascitis
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