PWE-39 A multidisciplinary approach to symptomatic umbilical hernia in patients with ESLD optimises outcome

Abstract

<h3>Introduction</h3> Symptomatic umbilical hernias can occur in up to 20% of patients with cirrhosis and end-stage liver disease. Management remains controversial due to a paucity of data. We aimed to determine the outcome and the factors predicting mortality following repair of symptomatic umbilical hernias in this group of patients. <h3>Methods</h3> A retrospective review was performed for all patients with ESLD who presented to a specialist liver transplant centre with a symptomatic umbilical hernia requiring repair between 1998 and 2020. Overall survival was predicted using the Kaplan-Meier method, with censoring at transplantation. Logistic regression was used to determine predictors of 365-day mortality. Statistical significance set at p&lt;0.05. <h3>Results</h3> 111 patients with ESLD underwent hernia repair (emergency n=81, 73%). Median UKELD was 51 (40-63). Mortality at 30d and 365d was 4.5% and 9.9%, respectively. Prior to repair 28 patients (25%) were awaiting transplantation; 19 patients (17%) were transplanted during follow-up. Patients presenting as an emergency were more likely to have varices (13 v 0 p=0.018) and encephalopathy (29 v 3 p=0.005). TIPS was performed in 29 patients (26%). Age, pre-operative bilirubin, sodium, creatinine, prothrombin time, albumin and UKELD were no different when comparing use of TIPS (p&gt;0.05). 44 patients (40%) required ITU admission. Decompensation occurred in 44 patients (40%), with variceal bleeding in 13 patients (12%) and encephalopathy in 33 patients (30%). Age&gt;60 (HR 4.5 p=0.026) and ITU admission (HR 10.5 p=0.001) predicted mortality within 365 days of surgery. The median length of stay was 11 days (0-304). TIPS predicted survival (OR 8.3, p=0.019). Median overall survival in the cohort was 64-months. <h3>Conclusions</h3> Symptomatic umbilical hernias in patients with cirrhosis can be treated safely with acceptable outcomes in a specialist liver transplant centre, however this remains a high risk intervention. We attribute our outcomes to a multidisciplinary approach to management of patients with ESLD and an umbilical hernia. TIPS may improve short-term outcomes but further prospective trials are warranted.