Gilbert double layer graft method for groin hernias in patients with ascites: A retrospective study of 81 patients

Patients with ascites undergoing an inguinal hernia repair have an increased rate of both morbidity and mortality compared with those without ascites, leading to controversy regarding the indications for herniorrhaphy in patients with ascites. The purpose of this retrospective study was to analyze the clinical results of a tension-free herniorrhaphy using the Gilbert approach in 81 patients with an inguinal hernia complicated by the presence of ascites.

We analyzed retrospectively the clinical data of 81 patients with ascites who underwent a tension-free hernia repair between November 2008 and November 2014 at the West China Hospital of Sichuan University. The underlay patch of the mesh device was spread to cover the entire posterior surface of the myopectineal orifice, while the onlay patch of the device was placed anterior to the transversalis fascia and fixed to the conjoint tendon and the inguinal ligament with single sutures. All patients were followed up via phone calls and outpatient examinations for 24 months until November 2016.

The operation was completed successfully in all patients. The mean operative time was 46 ± 20 minutes (range 20-255 minutes). A drain was left in the wound in 65 cases and was removed at a median of 3 days (interquartile range 2-4) after the operation. The hospital stay after the operation was 3 ± 2 days (range 1-12 days). Postoperative complications included a seroma in 9 patients, scrotal edema in 4 patients, and no wound infections. There was no recurrence of the hernia after 24 months of follow-up in any patient.

The Gilbert, double-layer, tension-free herniorrhaphy, according to the principles of the Gilbert operation, is both feasible and safe for selected patients with a symptomatic inguinal hernia who also have ascites.