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Risk factors for decompensation and death following umbilical hernia repair in patients with end-stage liver disease

Lookup NU author(s): Abdullah Malik, Sanjay PandanaboyanaORCiD, Gourab Sen, Dr Stuart McPhersonORCiD, Dr Jess Dyson, Professor Derek Manas, Dr Steven MassonORCiD, John Hammond

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Abstract

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. 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 characterise 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: One-hundred-and-eight 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 (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). Thirty-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 hyponatraemia 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 ESLD can be undertaken with acceptable outcomes in a specialist centre, 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.


Publication metadata

Author(s): Malik AK, Varghese C, Pandanaboyana S, Sen G, Robinson S, McPherson S, Dyson J, Manas DM, Masson S, Hammond JS

Publication type: Article

Publication status: Published

Journal: European Journal of Gastroenterology & Hepatology

Year: 2022

Volume: 34

Issue: 10

Pages: 1060-1066

Online publication date: 01/10/2022

Acceptance date: 02/04/2018

ISSN (print): 0954-691X

ISSN (electronic): 1473-5687

Publisher: Wolters Kluwer Health, Inc.

URL: https://doi.org/10.1097/MEG.0000000000002417

DOI: 10.1097/MEG.0000000000002417

PubMed id: 36062496


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