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World J Gastrointest Surg. Jul 27, 2016; 8(7): 476-482
Published online Jul 27, 2016. doi: 10.4240/wjgs.v8.i7.476
Umbilical hernia in patients with liver cirrhosis: A surgical challenge
Julio C U Coelho, Christiano M P Claus, Antonio C L Campos, Marco A R Costa, Caroline Blum
Julio C U Coelho, Antonio C L Campos, Marco A R Costa, Caroline Blum, Department of Surgery, Federal University of Parana, 80060-900 Curitiba, Parana, Brazil
Julio C U Coelho, Chief Division of Gastrointestinal Surgery and Liver Transplantation, Federal University of Parana, 80240-110 Curitiba, Parana, Brazil
Christiano M P Claus, Department of Surgery, Positive University, 81280-330 Campo Comprido, Parana, Brazil
Author contributions: Coelho JCU designed and wrote the manuscript; Claus CMP, Campos ACL, Costa MAR and Blum C search the literature and revised the article; all the authors gave the final approval.
Conflict-of-interest statement: The authors have no financial disclosure and no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Julio CU Coelho, MD, MS, PhD, Professor of Surgery, Chief Division of Gastrointestinal Surgery and Liver Transplantation, Federal University of Parana, Rua Bento Viana 1140, Ap. 2202, 80240-110 Curitiba, Brazil. coelhojcu@yahoo.com.br
Telephone: +55-41-32420560 Fax: +55-41-33223789
Received: January 27, 2016
Peer-review started: January 27, 2016
First decision: March 23, 2016
Revised: April 20, 2016
Accepted: May 10, 2016
Article in press: May 11, 2016
Published online: July 27, 2016
Processing time: 166 Days and 12.6 Hours
Abstract

Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites. Due to the enormous intraabdominal pressure secondary to the ascites, umbilical hernia in these patients has a tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge. Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, such as wound infection, evisceration, ascites drainage, and peritonitis. Intermittent paracentesis, temporary peritoneal dialysis catheter or transjugular intrahepatic portosystemic shunt may be necessary to control ascites. Hernia repair is indicated in patients in whom medical treatment is effective in controlling ascites. Patients who have a good perspective to be transplanted within 3-6 mo, herniorrhaphy should be performed during transplantation. Hernia repair with mesh is associated with lower recurrence rate, but with higher surgical site infection when compared to hernia correction with conventional fascial suture. There is no consensus on the best abdominal wall layer in which the mesh should be placed: Onlay, sublay, or underlay. Many studies have demonstrated several advantages of the laparoscopic umbilical herniorrhaphy in cirrhotic patients compared with open surgical treatment.

Keywords: Umbilical hernia; Liver transplantation; Liver cirrhosis; Ascites; Hernia repair; Surgical site infection; Mesh; Ascites drainage

Core tip: Umbilical hernia management in cirrhotics is controversial. Indication, timing, and surgical options of herniorrhaphy such as mesh use and laparoscopic access in these patients remain controversial. This comprehensive review shows that umbilical hernia prevalence is very high in cirrhotic patients with ascites. The etiopathogenesis of umbilical hernia in these patients is discussed in detail. Umbilical hernia management changed markedly in the last decades due to better medical care of cirrhotic patients. Ascites control is the mainstay to avoid surgical complications and recurrence.