A novel approach to managing ruptured umbilical hernias in cirrhosis
Romain Seppey1, Aditya Benjamin1, Paul Lambrakis1,2
1Trauma and Acute Care Surgery Unit, Liverpool Hospital, Sydney, New South Wales, Australia.
Background:
Ruptured umbilical hernias in patients with ascites (Flood Syndrome) is an uncommon problem with high morbidity and mortality. The treatment of patients experiencing Flood Syndrome is controversial, with a multitude of different treatments being proposed.
Method:
This paper presents our experience in treating Flood syndrome, and presents a standardized way of treating these patients.
Results:
Six consecutive patients with Flood syndrome were treated with the same standardized management and surgical technique. All patients had Cirrhosis (Child B and C). All were treated as open emergency operations, with no recurrence or post-operative complications.
Conclusion:
Though there is a lack of level I or II evidence, the data suggests that ruptured umbilical hernias in cirrhotic patients are a surgical emergency that can be optimally managed with operative management. We present a standardized technique for the repair of these hernias which is simple, reliable and appears to have reproducible results. The technique aims to provide a hermetic seal immediately peri-operatively and is supported by medical optimization of the post-operative period. Our small case series represents effective and safe management in appropriately selected patients.
