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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Surgical literature around 1980 has emphasized the technical challenge and the risks of cholecystectomy in cirrhotic patients reporting discouraging results. The aim of this study is the retrospective analysis of laparoscopic cholecystectomy in cirrhotics. The collected laparoscopic experience of 3 surgical groups for the last 5 years is reported. Cirrhotics were classified according to Child-Pugh criteria. Postoperative complications were classified using Clavien's rules. Forty patients were recruited; 31 received successful laparoscopic cholecystectomy. Liver cirrhosis was preoperatively diagnosed in all Child-Pugh B (n = 11) and in 11/20 Child-Pugh A patients. Compared with 989 noncirrhotics undergoing laparoscopic cholecystectomy, cirrhotics were similar in terms of age (59.9+/-10.3 vs. 58.1+/-10.9) and sex (male: 51.6% vs. 50.1%). Acute cholecystitis has a similar frequence in cirrhotics and noncirrhotics (3.2% vs. 4.1%, respectively). Bile duct stones and acute pancreatitis were significantly more frequent in cirrhotic patients (6.4% vs. 3.7%, p < 0.001; and 6.4% vs. 0.3%, p < 0.001, respectively). Endoscopic papillotomy and stone extraction combined with laparoscopic cholecystectomy was performed in 2 patients. Intraoperatively, technical problems occurred in 5 (16.1%) patients: liver bed bleeding (n = 4) was significatively more frequent in cirrhotics vs. noncirrhotics (p < 0.001). Mean operative time was 90 min, range 50-180, and it was not significantly longer than in noncirrhotics (85 min, range 30-200). Conversion rate was also similar (3%). Seven patients presented 8 postoperative complications (Class II): right side lung effusion (n = 2), ascites (n = 2), temporary worsening of Child-Pugh status (n = 2), hyperosmotic coma (n = 1), and umbilical hernia (n = 1). Mean hospital stay in noncomplicated cases was the same for noncirrhotics (3+/-1). The authors suggest a more liberal use of laparoscopic cholecystectomy for symptomatic gallstones in selected Child-Pugh A and B patients.
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PMID:Gallstones in cirrhotics revisited by a laparoscopic view. 944 15

We report herein the case of a patient with severe liver ascites due to cirrhosis in whom a small incisional hernia on a midline incision was successfully treated by a mesh plug repair, a method most commonly employed for groin hernia repair. The hernia sac was dissected and inverted into the abdominal cavity by the mesh plug under epidural anesthesia. The patient's recovery was quick and relatively painless, and there has been no recurrence after 1 year of followup. This case report demonstrates that the method of mesh plug repair may be appropriate for small incisional hernias as well as groin hernias, performed under epidural anesthesia.
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PMID:Mesh plug repair for a small incisional hernia in a cirrhotic patient with ascites: report of a case. 968 19

We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg.
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PMID:Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review. 1171 20

Umbilical hernias are common in patients with cirrhosis of the liver and ascites. However, spontaneous rupture of the hernia is not frequently seen. This is a serious complication and carries a high mortality. A search of the literature shows that patients have been managed both operatively and nonoperatively for this condition. We present a case of spontaneous rupture of an umbilical hernia in a patient with cirrhosis and ascites which was managed successfully with hernia repair.
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PMID:Ruptured umbilical hernia in a case of alcoholic cirrhosis with massive ascites. 1220 11

The treatment of umbilical hernia in the setting of cirrhosis poses unique and specific management problems due to the pathophysiology of cirrhotic ascites. The high intra-abdominal pressures generated by ascites when applied to areas of parietal weakness are the cause of hernia formation and enlargement. Successful surgical treatment depends on minimization or elimination of ascites. Umbilical rupture and hernia strangulation are the most life-threatening complications of umbilical hernia with ascites and they demand urgent surgical intervention. In non-emergency situations, medical therapy to control ascites should precede hernia repair. When ascites is refractory to medical therapy, treatment will vary depending on whether transplantation is an option. In liver transplantation candidates, hernia repair can be performed at the end of the transplantation procedure. If transplanation is not envisaged, concomitant treatment of both ascites and hernia is best achieved by placement of a peritoneo-venous shunt at the time of the parietal repair.
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PMID:[Management of umbilical hernia in cirrhotic patients]. 1239 63

This paper assesses the changes in avoidable mortality in Lithuania in 1991-1999 compared with 1970-1990. Causes of death were disaggregated into causes most amenable to treatment and those amenable to prevention. Trends in age-standardised death rates were calculated. In 1970-1990, avoidable causes of death accounted for 26.3% of all deaths. By 1991-1999 this figure had decreased slightly to 24.6%. At the same time, age-standardised death rates from avoidable causes increased by 8%, from 118.1 per 100000 in 1970-1990 to 127.9 in 1991-1999. Avoidable mortality among men was considerably higher than for women in both periods. There was considerable fluctuation in both treatable and preventable mortality during the 1990s, reflecting diversity in trends in different causes of death. Increases occurred in death rates from tuberculosis, cervical cancer and liver cirrhosis and, immediately after independence, also in hypertensive and cerebrovascular diseases and, among men, lung cancer, followed by subsequent declines. Deaths from chronic rheumatic heart disease, asthma and other respiratory diseases, appendicitis, abdominal hernia, cholelithiasis and maternal mortality consistently declined. In conclusion, avoidable mortality declined as a proportion of total mortality in Lithuania during 1991-1999 compared with 1970-1990. This reflected the combined impact of an initial rise in death rates from treatable and, to a lesser extent, preventable causes, followed by subsequent declines. While this indicates some success in the development of medical care, it emphasises the need for more effective public health policies directed at the major determinants of health.
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PMID:Avoidable mortality in Lithuania: 1991-199 compared with 1970-1990. 1500 9

The literature provides little data about incisional herniae (IH) developing after orthotopic liver transplantation (OLTx). We evaluated the incidence, predisposing factors, and results of surgical treatment of this pathological condition. We reviewed the records of 718 consecutive OLTx performed in 623 patients between April 1986 and May 2002. Patients whose IH developed after transplantation were included in the study. We identified 31 patients (incidence, 4.9%) whose IH developed from 2 to 140 months after the transplantation. This complication was significantly more frequent in men. Important predisposing factors included: virus-correlated cirrhosis, body mass index >25, severe ascites, incision type for OLTx (bilateral subcostal extended upper midline to xiphoid), and post-OLTx complications. In 17 patients, repair of hernia was performed using direct fascial approximation, in 20 patients, it required a prosthesis. After hernia treatment, we observed no deaths but a morbidity rate of 6.4%, a mean postoperative hospital stay of 8 days and a recurrence rate of 6.4%. IH post-OLTx need surgical treatment.
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PMID:Incidence, predisposing factors, and results of surgical treatment of incisional hernia after orthotopic liver transplantation. 1568 4

Spontaneous rupture of umbilical hernia is an unusual and rarely reported complication in the patient with hepatic cirrhosis and ascites, and it may be fatal. A literature search revealed that patients have been managed both operatively and nonoperatively for this condition. All of the reported cases in the literature were adults with liver disease and ascites. We present a first case of spontaneous rupture of an umbilical hernia in a child with cirrhosis and ascites, which was managed with primary repair of the hernia.
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PMID:Spontaneous ruptured umbilical hernia in a child with hepatic cirrhosis and ascites. 1571 41

Umbilical herniorrhaphy in cirrhotic patients with ascites is associated with a significant morbidity, recurrence rate, and mortality and therefore is often managed expectantly. Operative repair is indicated if an ascites leak or infection develops. Surgeons must consider the management of postoperative ascites to reduce recurrence rates and complications. We present a unique method using temporary peritoneal dialysis catheter placement (PD). Eight patients with moderate to massive ascites underwent umbilical herniorrhaphy with concomitant peritoneal dialysis placement. Patients have been followed for 8 to 30 months. All patients had successful repair of their hernia with 1 recurrence at 6 months and 1 late death (14 months). Patients were able to effectively control ascites using the PD catheter at home. There were no postoperative infections. The placement of a temporary PD catheter during umbilical herniorrhaphy provides a method for effective control of ascites in patients with cirrhosis. The technique has several advantages including outpatient management during the postoperative period and for easy removal of the catheter when no longer needed.
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PMID:Umbilical hernia repair in cirrhotic patients: utility of temporary peritoneal dialysis catheter. 1575 59

Cirrhosis is a significant marker of adverse postoperative outcome. A large national database was analyzed for abdominal wall hernia repair outcomes in cirrhotic vs. non-cirrhotic patients. Data from cirrhotics and non-cirrhotics undergoing inpatient repair of abdominal wall hernias (excluding inguinal) from 1999 to 2004 were obtained from the University HealthSystem Consortium (UHC) database. Differences (P < 0.05) were determined using standard statistical methods. Inpatient hernia repair was performed in 30,836 non-cirrhotic (41.5% male) and 1,197 cirrhotic patients (62.7% male; P < 0.0001). Cirrhotics had a higher age distribution (P < 0.0001), no race differences (P = 0.64), underwent ICU admission more commonly (15.9% vs. 6%; P < 0.0001), had a longer LOS (5.4 vs. 3.7 days), and higher morbidity (16.5% vs. 13.8%; P = 0.008), and mortality (2.5% vs. 0.2%; P < 0.0001) compared to non-cirrhotics. Several comorbidities had a higher associated mortality in cirrhosis: functional impairment, congestive heart failure, renal failure, nutritional deficiencies, and peripheral vascular disease. The complications with the highest associated mortality in cirrhotics were aspiration pneumonia, pulmonary compromise, myocardial infarction, pneumonia, and metabolic derangements. Cirrhotics underwent emergent surgery more commonly than non-cirrhotics (58.9% vs. 29.5%; P < 0.0001), with longer LOS regardless of elective or emergent surgery. Although elective surgical morbidity in cirrhotics was no different from non-cirrhotics (15.6% vs. 13.5%; P = 0.18), emergent surgery morbidity was (17.3% vs. 14.5%; P = 0.04). While differences in elective surgical mortality in cirrhotics approached significance (0.6% vs. 0.1%; P = 0.06), mortality was 7-fold higher in emergencies (3.8% vs. 0.5%; P < 0.0001). Patients with cirrhosis carry a significant risk of adverse outcome after abdominal wall hernia repair compared to non-cirrhotics, particularly with emergent surgery. It may, however, be safer than previously thought. Ideally, patients with cirrhosis should undergo elective hernia repair after medical optimization.
Hernia 2005 Dec
PMID:Poor outcomes in cirrhosis-associated hernia repair: a nationwide cohort study of 32,033 patients. 1613 87


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