Management and Outcomes of Umbilical Hernia in Decompensated Chronic Liver Disease: A Single-Unit Experience of Six Cases

TL;DR

This study examines the outcomes of emergency surgery for umbilical hernias in patients with severe liver disease, finding high risks and the importance of preoperative care.

Contribution

The paper provides a single-unit experience on managing complicated umbilical hernias in decompensated liver disease patients.

Findings

All six patients underwent emergency surgery with high morbidity and one death.

Bowel resection was needed in half the cases, and no mesh was used for hernia repair.

Postoperative recovery was uneventful in two-thirds of patients.

Abstract

Background

Complicated umbilical hernia in decompensated chronic liver disease is a significant cause of morbidity and mortality. This study evaluates the management strategies and factors predicting outcomes following emergency umbilical hernia repair.

Methods

A retrospective analysis was conducted on six patients with decompensated chronic liver disease who presented with complicated umbilical hernia in an emergency setting to the hepatopancreatobiliary (HPB) surgical unit between July and December 2024. Preoperative characteristics, intraoperative findings, and postoperative outcomes were reviewed.

Results

A total of six patients were included. The mean age was 51.16 years (range: 44-58), and all presented with abdominal pain (6, 100%). Among them, two (33.3%) presented with a strangulated umbilical hernia, two (33.3%) with an obstructed hernia, and two (33.3%) with a ruptured hernia associated with ascites fluid leak. All patients (6, 100%), underwent emergency surgery. Bowel resection was required in three (50.0%) patients, of whom two (33.3%) underwent primary anastomosis and one (16.7%) underwent a double-barrelled ileostomy. All six (100%) patients underwent primary repair of the hernial defect without mesh placement. Postoperative recovery was uneventful in four (66.7%) patients; one (16.7%) patient developed an ascites fluid leak, and one (16.7%) died. The mean postoperative hospital stay was 14.83 days.

Conclusion

Emergency repair of complicated umbilical hernia in patients with decompensated chronic liver disease is associated with high morbidity and mortality. Contributing factors include increased ascites, portal hypertension, and liver decompensation following surgery. Preoperative optimization and intraoperative ascites drainage may play a crucial role in improving outcomes, even in emergency settings.

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