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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this work the results of autopsy are presented--of a 45 years old man who died because of complications of cirrhosis in 24 months after repairing a postoperative hernia with the Matapurkar's "peritoneal sandwich" and polypropylene mesh. Macroscopically and histopathologically it has been shown that gradual healing of the mesh ends with formation of alloplastic-tissue connective structure, called neofascia that fills in the defect in fascia of the abdominal wall. Inflammatory process around implanted mesh maintains even after several months. It seems that parietal peritoneum of hernia sac that surrounds polypropylene mesh may have a tendency towards metaplasia in the direction of tissue-connective fascia layer.
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PMID:[The picture of abdominal cavity wall after surgical treatment of postoperative abdominal hernia with the Matapurkar's method of "peritoneal sandwich" in pathomorphological examinations]. 1652 74

A total of 23 consecutive patients operated upon on emergency basis for the treatment of complicated umbilical hernias associated with liver cirrhosis and ascites. The hernia was complicated by strangulation in 11 and ascitic fluid leak in twelve of the patients. Patients were assigned randomly in two groups. In the first group (GI, n = 12) peritoneal drainage at the conclusion of their surgery was done but no drainage was applied in the second group (GII, n=12). All patients were operated upon and when closed system peritoneal drainage was done, it was brought to outside of the abdomen through a separate stab. No negative pressure was applied. The main outcome measures were postoperative wound healing, control of ascites, complications, and hernia recurrence rate at follow up. The male/female ratio, Child's class, ascites severity, and mode of hernia complication were almost matched in both groups. Postoperative wound dehiscence occurred in four patients in G II (23.5%) but in none of GI. Control of ascites was achieved in all patients of GI. The overall mean hospital stay was significantly lower in-patient of GI than those of the G II (P < 0.0 1). Recurrences of the hernia occurred in one patient only of the G I and in three of the G II on a mean follow- up of 19+/-3 months. So, postoperative closed peritoneal drainage in the management of complicated umbilical hernias associated with liver cirrhosis and ascites safe and effective in assuring postoperative wound healing, control of ascites and the prevention of hernia recurrence. It is specifically indicated in cases with bowel resection anastomosis and in patients with low preoperative serum albumin and history of rapid ascites re-accumulation under medical therapy.
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PMID:New approach in surgical management of complicated umbilical hernia in the cirrhotic patient with ascites. 1736 67

A 10-yr-old boy with end-stage liver cirrhosis due to Wilson's disease received a living donor liver transplantation (LDLT) at our institution. The donor was his father and the graft was a left lateral segment. The liver transplantation procedure and the postoperative course were uneventful. Two months after the procedure, he developed a first episode of bowel obstruction that was treated with conservative therapy. During a second episode of bowel obstruction, he also presented respiratory distress. A plain chest X-ray revealed the presence of small intestine loops in the right thoracic cavity and bowel obstruction due to diaphragmatic hernia was diagnosed. Repair of the diaphragmatic hernia was performed and the patient has been doing well after the surgery. Diaphragmatic hernia after LDLT is rare but should be recognized as a possible complication when a left lobe or a left lateral segment graft is used.
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PMID:Bowel obstruction due to diaphragmatic hernia in an elder child after pediatric liver transplantation. 1743 Apr 91

Anterolateral hernias of the abdomen group together umbilical, epigastric, and spigelian hernias and diastasis of the abdominal rectus. In spigelian hernias, 90% are located in the subumbilical region at the Monro line. They are asymptomatic in 90% of cases. The risk of strangulation is 10%-25% and requires surgical treatment. A herniorrhaphy is sufficient if the ring is less than 2 cm in diameter. Beyond 2 cm, open or celioscopic mesh repair is necessary. The risk of recurrence is less than 2%. Umbilical hernias result from progressive enlargement of the umbilical ring. The risk of strangulation is higher than 10%. The morbidity and mortality rate reaches 15% in large strangulated hernias. All umbilical hernias should therefore be treated surgically. If their diameter is under 2 cm, a simple herniorrhaphy can be done; otherwise mesh repair is required. In the cirrhosis patient, hernia treatment is part of the ascites treatment. The indication for surgery depends on liver function. Epigastric hernias are most often symptomatic: 80% have a ring smaller than 25 mm and 20% are multifocal. The risk of strangulation is low. If the ring is less than 20 mm, these hernias can be treated by herniorrhaphy. Recurrence is frequent - more than 10% - and always difficult to treat. Diastasis of the recti does not lead to complication, and treatment is not necessary. Cosmetic surgery can be used to manage diastasis.
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PMID:[Anterolateral hernias of the abdomen]. 1806 14

Several reasons result in the finding that patients with cirrhosis need surgery more often than other patients groups. Patients with cirrhosis frequently have comorbidities resulting in gastrointestinal, lung or cervical cancer, among others. Independent of cirrhosis, surgical resection may be the best alternative for a number of those malignancies. Comorbidities may also result in an increased incidence of vascular complications (such as lower extremity atherosclerosis and coronary stenosis) some of them being potential indications for surgery. Patients with alcoholic cirrhosis are more frequently subjected to trauma and bone fractures. Ascites leads to umbilical hernia which can be strangulated or ruptured. Emergency surgery may be needed in this context. Finally, a significant proportion of patients with cirrhosis develop hepatocellular carcinoma (HCC) during the course of the disease. Surgical resection remains a first line option for HCC. While reliable guidelines have been proposed for surgical resection of HCC and liver transplantation, no precise guidelines are available for other aspects of surgical management during cirrhosis. Specific surgical procedures such as hepatectomy and transplantation are concentrated in highly specialised centres, where detailed evaluation is relatively easy to obtain. In contrast, more general surgical procedures, either abdominal or non abdominal, are performed in various centres, making it more difficult to obtain detailed evaluation and draw recommendations. General surveys are still needed to precisely assess the risk of non-specific surgery in patients with cirrhosis, to identify risk factors and to propose reliable guidelines.
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PMID:The risk of surgery in patients with cirrhosis. 1839 51

This report describes a 64-year-old man with Laennec cirrhosis requiring a transjugular intrahepatic portosystemic shunt (TIPS) to alleviate ascites before surgical mesh repair of a large symptomatic umbilical hernia. During the procedure, both internal jugular veins and the right external jugular vein were found to be occluded. The right subclavian vein was accessed and a TIPS was successfully created. Some of the technical challenges encountered in performing the procedure from the right subclavian vein are described.
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PMID:Technical challenges in TIPS creation via the right subclavian vein. 1895 Oct 43

Digestive surgery in cirrhotic patients has long been limited to the treatment of disorders related to the liver disease (portal hypertension, hepatocellular carcinoma and umbilical hernia). The improvement in cirrhotic patient management has allowed an increase in surgical procedures for extrahepatic indications. The aim of this study was to evaluate the operative risks of such surgical procedures. Extrahepatic surgery in cirrhotic patients is associated with high mortality and morbidity. Emergency surgery, gastrointestinal tract opening (esophagus, stomach and colon), <30 g/L serum albumin, transaminase levels more than three times the upper limit of normal, ascites, and intraoperative transfusions are the main risk factors for postoperative death. In Child A patients, the operative risk of elective surgery is moderate and surgical indications are not altered by the presence of cirrhosis. The laparoscopic approach should be recommended because of the potentially lower morbidity. In Child C patients, operative mortality is often higher than 40%; surgical indications must remain exceptional and non operative management has to be preferred. In Child B patients, preoperative improvement of liver function is mandatory for lower risk surgery.
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PMID:Operative risks of digestive surgery in cirrhotic patients. 1948 92

A 48-year-old Indian male with alcoholic liver cirrhosis was admitted after being found unresponsive. He was hypotensive and had hematochezia. Esophagogastroduodenoscopy (EGD) showed small esophageal varices and a clean-based duodenal ulcer. He continued to have hematochezia and anemia despite blood transfusions. Colonoscopy was normal. Repeat EGD did not reveal any source of recent bleed. Twelve days after admission, his hematochezia ceased. He refused further investigation and was discharged two days later. He presented one week after discharge with hematochezia. EGD showed non-bleeding Grade 1 esophageal varices and a clean-based duodenal ulcer. Colonoscopy was normal. Abdominal computed tomography (CT) showed liver cirrhosis with mild ascites, paraumbilical varices, and splenomegaly. He had multiple episodes of hematochezia, requiring repeated blood transfusions. Capsule endoscopy identified the bleeding site in the jejunum. Concurrently, CT angiography showed paraumbilical varices inseparable from a loop of small bowel, which had herniated through an umbilical hernia. The lumen of this loop of small bowel opacified in the delayed phase, which suggested variceal bleeding into the small bowel. Portal vein thrombosis was present. As he had severe coagulopathy and extensive paraumbilical varices, surgery was of high risk. He was not suitable for transjugular intrahepatic porto-systemic shunt as he had portal vein thrombosis. Percutaneous paraumbilical embolization via caput medusa was performed on day 9 of hospitalization. Following the embolization, the hematochezia stopped. However, he defaulted subsequent follow-up.
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PMID:Percutaneous paraumbilical embolization as an unconventional and successful treatment for bleeding jejunal varices. 1967 28

Umbilical hernia repair is often accompanied by complications in patients with liver cirrhosis and ascites. In recent years we have been using the following concept for treating umbilical hernias in such patients: repair of the hernia by direct sutures and concomitant implantation of two large bore Robinson drainage tubes until the wound healing was completed within the next postoperative 10-14 days. During this time the reconstruction of the abdominal wall is in our opinion as robust that the ascites no longer represents a risk. Preconditions to perform this procedure were the best medicamentous treatment of ascites as ever possible and the perioperative administration of prophylactic antibiotics like gyrase inhibitors to avoid spontaneous bacterial peritonitis. Over a period of 10 years (01.01.1997-31.12.2006) we operated on 22 patients suffering from liver cirrhosis and ascites because of a complicated umbilical hernia (incarceration, irreponibility, skin ulceration, leackage of ascites). One group of patients (n=10) was treated by umbilical hernia repair with the concomitant implantation of two drainage tubes and the other group (n=12) by umbilical hernia repair without draining off the ascites. Morbidity and mortality were compared in both groups in a retrospective analysis. The postoperative morbidity could be reduced from 25% to 10% by using the drainage tubes as well as the rate of recurrent hernias in the drainage group. Due to these experiences we use the concept as standard in such patients and would like to recommend it further. However, we would like to initiate a prospective, randomized, at best multicenter trial for further validation.
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PMID:[Complicated umbilical hernia in patients with decompensated liver cirrhosis. Concept for risk reduction of repair]. 1981 6

The outcome of hernia repair in patients with cirrhosis remains poor when compared to non-cirrhotics. The aim of our study was to evaluate the outcome of hernia repair in cirrhotic patients at our tertiary care hospital located in a developing country. A total of 61 patients with cirrhosis underwent hernia repair from January 2001 to December 2007 at our hospital. The mean age of the patients was 52 years and there were 30 males. Early postoperative complications were noted in 20 (33%) patients including two mortalities. The incidence of early complications was higher (71%) in patients with Child class C cirrhosis as compared to patients with either Child class A or B cirrhosis (21%), and the difference was statistically significant (P < 0.001). Except in emergency circumstances, surgery in Child class C patients may either be delayed until the patient is medically optimized or performed early before liver disease progresses to severe decompensation.
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PMID:Abdominal wall hernia repair in cirrhotic patients: outcomes seen at a tertiary care hospital in a developing country. 1985 Jun 8


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