Safety and effectiveness of umbilical hernia repair in patients with cirrhosis

Umbilical hernia is a common complication in patients with cirrhosis. Early studies have reported a high morbidity and mortality associated with hernia repair. The traditional approach has been to non-operatively manage umbilical hernias in patients with cirrhosis. There are emerging data suggesting that an elective repair is a preferable approach. This study examined the outcomes of umbilical hernia repair in patients with advanced liver disease and compared this with a control group of non-cirrhotic patients.

Prospective data were collected regarding the outcome of umbilical hernia repairs performed between 2004 and 2013 at the Austin Hospital, Melbourne, Australia. Outcomes at 90 days were compared between patients with and without cirrhosis.

79 patients with cirrhosis and 249 controls were analysed. Of the patients with cirrhosis, 9% were classified as Child-Pugh A, 61% were Child-Pugh B and 30% were Child-Pugh C. Emergency repairs for complicated hernias was undertaken in 18% of the cirrhosis population and 10% in controls (P = 0.10). Post-operative complications occurred more commonly in patients with cirrhosis (26%) compared with controls (11%) (P < 0.01). Emergency hernia repairs were associated with a higher complication rate in both patients with cirrhosis (62%) and controls (20%) (P = 0.01). There was no significant difference in the rate of hernia recurrence as assessed by clinical examination between patients with cirrhosis (2.7%) and controls (6.8%) (P = 0.17) nor in 90-day mortality between patients with cirrhosis (n = 1, 1.3%) and the controls (n = 0) (P = 0.43).

Within the limitations of a small study cohort and therefore an underpowered study, elective surgical repair of umbilical hernias in patients with cirrhosis, including decompensated cirrhosis, may not be associated with a significant increase in mortality when compared to a control cohort. Whilst complications are higher in cirrhotic patients, there is no difference in the rate of hernia recurrence. Emergency repairs of umbilical hernias are associated with a high complication rate in cirrhotic patients.