Liver and Bile
Eur J Gastroenterol Hepatol. 2022;34(10):1060–6
Risk factors for decompensation and death following umbilical hernia repair in patients with end-stage liver disease
Introduction: Symptomatic umbilical hernias are a common cause of morbidity and mortality in patients with cirrhosis and end-stage liver disease (ESLD). This study set out to characterize the factors predicting outcome following repair of symptomatic umbilical hernias in ESLD at a single institution.
Methods: A retrospective review was performed of all patients with ESLD who underwent repair of a symptomatic umbilical hernia between 1998 and 2020. Overall survival was predicted using the Kaplan-Meier method. Logistic regression was used to determine predictors of decompensation and 30-day, 90-day and 1-year mortality.
Results: 108 patients with ESLD underwent umbilical hernia repair (emergency, n = 78; 72.2%). Transjugular shunting was performed in 29 patients (26.9%). Decompensation occurred in 44 patients (40.7%) and was predicted by emergency surgery (odds ratio [OR] = 13.29; p = 0.001). Length of stay was shorter in elective patients compared to emergency patients (3 days vs. 7 days; p = 0.003). 30-day, 90-day and 1-year survival was 95.2%, 93.2% and 85.4%, respectively. Model for ESLD score > 15 predicted 90-day mortality (OR = 18.48; p = 0.030) and hyponatremia predicted 1-year mortality (OR = 5.31; p = 0.047). Transjugular shunting predicted survival at 1 year (OR = 0.15; p = 0.038).
Conclusions: Repair of symptomatic umbilical hernias in patients with end-stage liver disease can be undertaken with acceptable outcomes in a specialist center, however, this remains a high-risk intervention. Patients undergoing emergency repair are more likely to decompensate postoperatively, develop wound-related problems and have a longer length of stay. Transjugular shunting may confer a benefit to survival, but further prospective trials are warranted.