Umbilical hernias and cirrhose.

Area of Science:

• Gastroenterology and Hepatology
• Abdominal Surgery
• Surgical Oncology

Background:

• Umbilical hernia (UH) is a common complication of ascites in cirrhotic patients.
• Effective ascites management, via paracentesis or transjugular intrahepatic portosystemic shunt (TIPS), is crucial for preventing UH recurrence.
• Historically, UH repair was reserved for symptomatic cases, but current trends favor elective repair to mitigate risks of emergency surgery.

Purpose of the Study:

• To review current management strategies for umbilical hernias in cirrhotic patients.
• To discuss the indications and timing of UH repair in relation to liver transplantation.
• To outline surgical approaches, including laparoscopic techniques and prosthetic material use.

Main Methods:

• Literature review of studies on umbilical hernia in cirrhotic patients.
• Analysis of treatment options for ascites control.
• Evaluation of surgical repair techniques, including laparoscopic and open approaches.
• Consideration of prosthetic mesh use and infection risk.
• Assessment of simultaneous UH repair during liver transplantation.

Main Results:

• Ascites control is mandatory to reduce UH recurrence risk.
• Elective UH repair is increasingly preferred over emergency surgery due to high complication rates.
• Simultaneous UH repair with liver transplantation is feasible under specific conditions.
• Laparoscopic repair offers advantages for large UH by avoiding skin incisions and mesh contamination.
• Prosthetic material can be used safely in large defects if ascites is sterile.

Conclusions:

• Management of umbilical hernia in cirrhotic patients necessitates integrated care focusing on ascites control and timely surgical intervention.
• Elective repair and advanced techniques like laparoscopy improve outcomes and reduce morbidity.
• Careful patient selection and surgical planning are essential, especially when considering liver transplantation.