Hernia ventral en paciente cirrótico ascitógeno. Cierre parietal y dos prótesis supraaponeuróticas superpuestas: biológica y polipropileno

Abstract

The cirrhotic patient have special anesthetic and surgical risk: hepatic failure, coagulation disorders and the possibility of ascetic decompensation. Therefore we designed a surgical technique for repair their ventral hernias.We present an observational study about the repair of ventral hernias in 13 patients with liver disease with background of ascitic decompensation. All patients underwent the same surgical technique consistingin a primary closure and two supra-aponeurotic overlapped prosthesis (biological deep, and polypropylene superficial).Operated from May 2010 to February 2015, the mean follow up is 25.3 months. Were 9 men and 4 women. With age-averageis 57.8 years. Umbilical hernias were 8, epigastric 3 and infra-umbilical 2; 9 primary and 4 post-surgery. Anesthetic risk were ASA-III, ASA-IV. Child-Pugh B and C. The general anesthesia was applied to all. The operative time average was 45minutes. Hospital care was performed by surgeons and hepatologists; the stay average was 5.9 days. Local complications were infrequent; 4 had hepatic decompensation; we have not detected recurrences.The hernia deteriorate the quality of life in cirrhotic patient, and we must be able to resolve them. Our technique is based in onlay techniques an in the use of dual prosthesis. The biological prosthesis proof the suture, an the polypropylene prosthesis reinforces the repair.It is a fast, safe and simple procedure, available to any general surgeon. Possible complications appear in the surface plane, facilitating its resolution.