Outcomes/Effectiveness Research

Cirrhosis of the liver does not increase risk during surgical repair of umbilical hernias, unless the procedure is an emergency

Repairing umbilical hernias before they create problems requiring emergency surgery may improve the overall outcomes for patients with cirrhosis of the liver, according to a new study of patients treated at Department of Veterans Affairs (VA) hospitals. Earlier studies had shown that patients with cirrhosis who underwent emergency surgery to repair umbilical hernias (abdominal protrusions through the area of the belly button) had increased morbidity and mortality compared with patients without cirrhosis. In contrast, the new study found no increased risk for patients with cirrhosis who underwent the procedure as elective surgery, that is, when it was not an emergency.

Repair of umbilical hernias is relatively straightforward among patients considered to be good surgical risks. In this group of patients, morbidity and mortality associated with the surgery is low. Because many surgeons consider patients with cirrhosis to be high-risk, umbilical hernia repair is often delayed until bowel-related complications occur, which only increases the risk of surgery.

To determine the influence of elective versus emergency surgery on the outcome of umbilical hernia repair, the researchers looked at the records for patients undergoing this procedure between 1998 and 2002 at 16 VA medical centers across the United States associated with surgical residency programs. Of the 1,421 procedures with enough information for analysis (92.5 percent first-time repairs and 7.5 percent rerepairs), 127 were in patients with documented cirrhosis.

The proportion of patients with cirrhosis who underwent emergency repair (26.0 percent) or repair of a recurrent hernia (11.8 percent) was significantly larger than for noncirrhotic patients (4.8 percent for emergency repair and 7.0 percent for recurrent repair). Complications after surgery occurred in 86 patients (6.1 percent); 6 deaths occurred within 30 days of the surgery, including 1 in a patient with cirrhosis. >Patients with cirrhosis were significantly more likely than those without the condition to require bowel resection (8.7 percent versus 0.8 percent) or return to the operating room within 30 days of the umbilical repair (7.9 percent versus 2.5 percent).

The study was funded in part by the Agency for Healthcare Research and Quality (T32 HS13852).

More details are in "Umbilical herniorrhapy in cirrhosis: Improved outcomes with elective repair," by Stephen H. Gray, M.D., Catherine C. Vick, M.S., Laura A. Graham, M.P.H., and others in the Journal of Gastrointestinal Surgery 12(4), pp. 675–681, 2008.

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