Abdominal and inguinal hernia in cirrhotic patients: what's the best approach?

Traditionally, elective abdominal procedures in cirrhotic patients have been largely discouraged due to high morbidity and mortality consequent to complications of cirrhosis, described by several authors. Other services, however, obtained different results, advocating in favor of elective surgery.

A literature review using as key-words "abdominal wall hernia" and "cirrhotic patients" was performed using PubMed database. Twenty-eight articles were considered.

The incidence of abdominal wall hernias is relatively high in cirrhotic patients, specially those with ascites, and many of these are unfavorable and require specific surgical treatment. Currently, with the advent of MELD score for organ allocation, many centers are reconsidering their approach on leading these situations, since most of patients in question are on waiting list for liver transplantation. Thus elective surgery has achieved major position in managing this condition in order to reduce morbidity and mortality in these patients. Moreover, the quality of life was an important factor to be considered, being badly damaged in this condition.

Few studies with large samples have been conducted so far and there is no consensus on which conduct is the most suitable taking into consideration rates of morbidity and mortality.