Inguinal hernia repair in cirrhotic patients with ascites

Abstract

AIM: Cirrhotic patients with ascites have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical treatment as well as timing of inguinal hernia repair in this situation remains controversial. In the present study, we aim to address the safe and risk profile of inguinal hernia repair in cirrhotic patients with ascites. MATERIALS AND METHODS: Major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies published through October 2019 were identified, using the keywords: “inguinal hernia,” “liver cirrhosis,” “ascites,” “hernia repair,” including various combinations of the terms, all relevant articles and reference lists in these original studies were also obtained from the above databases. RESULTS: Nine articles were identified on inguinal hernia repair in cirrhotic patients with ascites. Various anesthetic methods and repair techniques were used to repair inguinal hernia in this situation. The frequent postoperative complications were minor-wound complications, with an overall incidence of 15.4% in elective surgery, which could be managed with conservative treatment. While, emergent surgery was associated with increased wound complications. The recurrence rate was 2.0%, the average of postoperative 30-day mortality was 1.0%, and none of the death was attributable to the complications of inguinal hernia repair and their treatment. CONCLUSION: Elective inguinal hernia repair in cirrhotic ascites is safe and should be advocated. Emergent surgery is associated with increased wound complications. Although the data are insufficient to support a specific technique, mesh repair has advantages with regard to long-term recurrence rate.