Prospective analysis of outcomes in umbilical hernia repair for patients with decompensated cirrhosis

Abstract

Background Elective umbilical hernia repair (UHR) is recommended for symptomatic patients who have decompensated cirrhosis with ascites. However, the exact timing, the type of surgery, and the factors affecting the outcomes are not clearly defined.

Methods We prospectively collected data of patients with decompensated cirrhosis and ascites, who underwent UHR between January 2016 and July 2024. Complications and mortality were recorded during the early post-surgery period, at 30 days, at 3 months, and at 12 months after surgery. Our aim was to assess the short-term and long-term outcomes of decompensated cirrhotic patients who underwent either elective or emergency UHR.

Results We included 19 patients (15 male), median model for end-stage liver disease score 15 (interquartile range [IQR] 11-39), who underwent UHR (16 emergent, 3 elective). Median survival time at 12 months after UHR was 5.5 months (IQR 0.3-86), whereas the mortality rates at 12 months were up to 68.42% (13/19 patients). No association was found between survival and type of surgery, type of anesthesia, preoperative use of diuretics, ascites grade or laboratory findings. Survival rates at 30 days (P=0.086), 3 months (P=0.022), and 12 months (P=0.031) postoperatively were better in patients who underwent emergent UHR.

Conclusions UHR in decompensated cirrhotics is associated with high mortality. Several risk factors are implicated in the outcomes, with the severity of liver disease having a central role.

Keywords Umbilical hernia repair, cirrhosis, mortality, survival, risk factors

Ann Gastroenterol 2025; 38 (6): 699-708