Our Summary

This paper discusses the treatment of umbilical hernias in patients with liver cirrhosis. These hernias can be challenging to manage due to the high risk of complications and recurrence after surgery. Historically, doctors often delayed treatment to avoid these risks.

The paper suggests that controlling ascites, which is the buildup of fluid in the abdomen often seen in cirrhosis patients, is key to successful hernia repair. This can be done through medication, draining the fluid before surgery, or reducing blood pressure in the liver using a special type of shunt (a tube that allows fluid to move from one area to another).

The paper recommends opting for planned surgery rather than emergency surgery to reduce complications and improve outcomes. This allows for better patient selection, optimal timing for the surgery, and dedicated care before and after the operation.

The paper also discusses using certain scoring systems to identify patients who may be candidates for a liver transplant. These patients should be evaluated early for potential listing for a transplant and simultaneous hernia repair.

Finally, the paper mentions that there is some evidence suggesting that using a surgical mesh might reduce the chances of the hernia coming back without significantly increasing the risk of complications. However, this evidence is of low quality and should be interpreted with caution. In conclusion, preventing emergency surgery and optimizing care before and after surgery are critical to reducing complications and improving outcomes in patients with umbilical hernias and cirrhosis.

FAQs

  1. How can the risk of complications during umbilical hernia repair be managed in patients with liver cirrhosis?
  2. What are the benefits of planned surgery over emergency surgery for umbilical hernia repair in cirrhosis patients?
  3. What role does a surgical mesh play in umbilical hernia repair for patients with cirrhosis and what are the risks associated with it?

Doctor’s Tip

Overall, a doctor might advise a patient undergoing hernia repair to focus on controlling ascites, consider planned surgery rather than emergency surgery, and potentially discuss the use of surgical mesh with their healthcare provider. It is important to discuss all options and potential risks with your doctor to determine the best course of action for your individual situation.

Suitable For

Patients who are typically recommended for hernia repair include those with:

  1. Symptomatic hernias: Patients experiencing pain, discomfort, or other symptoms due to the hernia are usually recommended for surgery to repair the hernia and alleviate their symptoms.

  2. Large hernias: Hernias that are large in size are at higher risk of complications such as incarceration or strangulation, and therefore surgery is often recommended to prevent these complications.

  3. Patients with high physical activity levels: Individuals who engage in physically demanding activities or heavy lifting may be recommended for hernia repair to prevent the hernia from worsening or causing further complications.

  4. Patients with hernias that affect daily activities: Hernias that interfere with daily activities, such as work or exercise, may be recommended for surgery to improve quality of life and functionality.

  5. Patients with recurrent hernias: Individuals who have had a hernia repair in the past and are experiencing a recurrence may be recommended for another surgery to address the issue and prevent further recurrences.

  6. Patients with certain medical conditions: Individuals with medical conditions such as cirrhosis, as discussed in the paper, may require hernia repair to prevent complications related to the hernia and their underlying medical condition.

Overall, the decision to recommend hernia repair is based on the individual patient’s symptoms, risk factors, and overall health status, with the goal of improving quality of life and reducing the risk of complications.

Timeline

Before hernia repair:

  1. Patient may experience symptoms such as pain, discomfort, and a visible bulge at the site of the hernia.
  2. Patient may undergo diagnostic tests such as physical examination, ultrasound, or MRI to confirm the presence of a hernia.
  3. Patient may be advised to make lifestyle changes to reduce the risk of complications during and after surgery.
  4. Patient may be prescribed medications to manage symptoms or to control underlying conditions such as ascites in cirrhosis patients.

After hernia repair:

  1. Patient undergoes hernia repair surgery, which can be done through open surgery or laparoscopic surgery.
  2. Patient is monitored closely for any complications during the recovery period, such as infection, bleeding, or hernia recurrence.
  3. Patient may be advised to avoid heavy lifting or strenuous activities for a certain period of time to allow the surgical site to heal properly.
  4. Patient may undergo follow-up appointments to check on the healing process and to address any concerns or complications that may arise.
  5. Patient may be recommended to participate in physical therapy or rehabilitation programs to aid in recovery and to prevent future hernias.

Overall, the timeline for a patient before and after hernia repair involves diagnosis, preparation, surgery, recovery, and follow-up care to ensure a successful outcome and minimize the risk of complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hernia repair in the context of liver cirrhosis include:

  1. What are the risks and benefits of delaying hernia repair surgery in patients with liver cirrhosis?
  2. How can ascites be managed or controlled before hernia repair surgery?
  3. What are the options for reducing ascites before surgery, such as medication or draining the fluid?
  4. What is the role of a liver shunt in reducing ascites before hernia repair surgery?
  5. What are the advantages of planned surgery over emergency surgery for hernia repair in patients with liver cirrhosis?
  6. How can patient selection and timing of surgery be optimized for better outcomes?
  7. How can care be improved before and after hernia repair surgery in patients with liver cirrhosis?
  8. How can scoring systems help identify patients who may be candidates for a liver transplant and simultaneous hernia repair?
  9. What is the evidence for using surgical mesh in hernia repair in patients with liver cirrhosis, and how does it affect the risk of complications?
  10. What are the potential benefits of using surgical mesh in reducing the recurrence of hernias in patients with liver cirrhosis?

Reference

Authors: Bronswijk M, Jaekers J, Vanella G, Struyve M, Miserez M, van der Merwe S. Journal: Hernia. 2022 Dec;26(6):1447-1457. doi: 10.1007/s10029-022-02617-7. Epub 2022 May 4. PMID: 35507128