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Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality.

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Andraus, Wellington Pinheiro, Rafael Soares Lai, Quirino Haddad, Luciana B P Nacif, Lucas S Lerut, Jan [UCL]

(eng) BACKGROUND: Patients with cirrhosis have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical management strategy as well as timing of abdominal hernia repair remains controversial. METHODS: A cohort study of 67 cirrhotic patients who underwent hernia repair during the period of January 1998-December 2009 at the University Hospital of Sao Paulo were included. After meeting study criteria, a total of 56 patients who underwent 61 surgeries were included in the final analysis. Patient characteristics, morbidity (Clavien score), mortality, Child-Turcotte-Pugh score, MELD score, use of prosthetic material, and elective or emergency surgery have been analysed with regards to morbidity and 30-day mortality. RESULTS: The median MELD score of the patient population was 14 (range: 6 to 24). Emergency surgery was performed in 34 patients because of ruptured hernia (n = 13), incarceration (n = 10), strangulation (n = 4), and skin necrosis or ulceration (n = 7). Elective surgery was performed in 27 cases. After a multivariable analysis, emergency surgery (OR 7.31; p 0.017) and Child-Pugh C (OR 4.54; p 0.037) were risk factors for major complications. Moreover, emergency surgery was a unique independent risk factor for 30-day mortality (OR 10.83; p 0.028). CONCLUSIONS: Higher morbidity and mortality are associated with emergency surgery in advanced cirrhotic patients. Therefore, using cirrhosis as a contraindication for hernia repair in all patients may be reconsidered in the future, especially after controlling ascites and in those patients with hernias that are becoming symptomatic or show signs of possible skin necrosis and rupture. Future prospective randomized studies are needed to confirm this surgical strategy.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2015
Language Anglais
Journal information "BMC Surgery" - Vol. 15, no. 1, p. 65 [1-7] (2015)
Peer reviewed yes
Publisher BioMed Central Ltd. ((United Kingdom) London)
e-issn 1471-2482
Publication status Publié
Affiliations UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation
UCL - (SLuc) Service de chirurgie et transplantation abdominale
Keywords abdominal hernia ; liver cirrhosis ; ascites
Links
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Bibliographic reference Andraus, Wellington ; Pinheiro, Rafael Soares ; Lai, Quirino ; Haddad, Luciana B P ; Nacif, Lucas S ; et. al. Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality.. In: BMC Surgery, Vol. 15, no. 1, p. 65 [1-7] (2015)
Permanent URL http://hdl.handle.net/2078.1/159222