ELECTIVE REPAIR OF ABDOMINAL-WALL HERNIAS IN DECOMPENSATED CIRRHOSIS

BACKGROUND/AIMS: Abdominal wall hernia is a common feature of decompen sated cirrhosis. However, literature on elective hernia repair in thes e patients is limited. Here we report the experience of our center. ME THODOLOGY: Eleven hernias (seven umbilical, three inguinal and one inc isional) in nine patients with decompensated cirrhosis were repaired. The indication for operation was repeated incarceration in two patient s and significant pain in four; three patients with umbilical hernias had ulceration and necrosis of the overlying skin. Pre-operatively, me dical therapy of ascites was conducted at the hepatology unit. Umbilic al hernias were treated with the classic Mayo repair; in all cases but two, this was buttressed with a prolene graft. One inguinal hernia wa s repaired with the plication-darn technique; the other two and the in cisional hernia were repaired with prolene grafts. RESULTS: There was no mortality. One patient had a scrotal hematoma; two patients had lea kage of ascites into the wound. Seven patients were followed up. Four patients died without recurrence after a median period of 12 months (r ange 6-22). The other patients have no recurrence at 1, 10 and 40 mont hs post-operatively. CONCLUSIONS: Umbilical and inguinal hernias in pa tients with decompensated cirrhosis may be repaired safely on an elect ive basis. Control of ascites is vital for success.