Page 3 - Journal of WALS

WJOLS

10.5005/jp-journals-10007-1150
ORIGINAL RESEARCH Laparoscopic Ventral Hernia Repair in Patients with Child C Cirrhosis: Our Experience
Laparoscopic Ventral Hernia Repair in Patients with

Child C Cirrhosis: Our Experience

Bharati V Hiremath, Nitin Rao, Bharathi Raja

ABSTRACT to the umbilicus via portosystemic venous communication. 6
The incidence of ventral hernias in cirrhotic patients with
Cirrhosis with refractory ascites was considered a
1
contraindication to laparoscopic surgery, until recently. tense ascites is around 20%. 7
However, current literature has shown the efficacy and safety Studies have shown that open repair of ventral hernias
of various laparoscopic procedures in the diagnosis and in these patients is associated with a high rate of recurrence
management of surgical conditions in cirrhotic patients. The
incidence of ventral hernias in cirrhotic patients with tense ascites in the era of only suture repair. However, in the present era
is high. It is well known that open hernia repair in patients with of prosthetic mesh though the recurrence rate has decreased
ascites is associated with high morbidity and mortality due to the rate of wound complications still remains high. 6
ascitic leak from wound site, wound infection and high recurrence Hence, the routine repair of these hernias is usually
2,3
rate. In view of high complication rate for surgical repair in
these patients most surgeons defer elective repair of hernias in avoided due to the dreaded complications such as
these patients. But, left alone ventral hernias in such patients postoperative ascitic fluid leak, wound infection and
may undergo complications, such as rupture, obstruction, subsequently high recurrence rate. But when these patients
strangulation, which are life-threatening. Hence, elective surgical present with complications, such as obstruction or imminent
repair of ventral hernias in these patients should be considered.
Laparoscopic ventral hernia repair in these patients helps to rupture surgery become inevitable and the rate of
overcome the complications and allows earlier recovery. There postoperative complications in such situations remains very
have been very few studies to evaluate the efficacy of high.
laparoscopic ventral hernia repair in patients with child A In order to overcome these complications, we subjected
cirrhosis. However, there is no literature on efficacy of this
procedure in child C cirrhotic patients. This is a retrospective these patients to intraperitoneal laparoscopic hernia repair
study to evaluate the efficacy of laparoscopic repair using a with the use of a dual mesh.
dual mesh in child C cirrhotic patients with tense ascites and The advantages of this procedure are as follows:
complicated ventral hernias.
• Not extending the existing defect in the fascia as is
Keywords: Laparoscopic ventral hernia, Cirrhosis, Mesh repair. required in the open repair.
How to cite this article: Hiremath BV, Rao N, Raja B. • The use of intraperitoneal dual mesh prevents leakage
Laparoscopic Ventral Hernia Repair in Patients with Child C of ascitic fluid.
Cirrhosis: Our Experience. World J Lap Surg 2012;5(2):59-62. • The large collateral veins over the anterior abdominal
Source of support: Nil wall in these patients are not interrupted.
• Prevention of exposure of viscera prevents losses of
Conflict of interest: None declared
electrolytes and proteins.
INTRODUCTION • There is minimal intraoperative blood loss.
Cirrhosis is a chronic progressive condition which is PATIENTS AND METHODS
characterized by fibrosis and the replacement of normal Retrospective analysis was done in three patients, two with
4
hepatic architecture by abnormal nodules. The physiologic ascites due to cirrhotic liver disease (child C) and in one
and metabolic changes in these cirrhotic patients lead to patient with Budd-Chiari syndrome. Patients who were
coagulation defects, fluid retention, poor resistance to included were those with tense ascitis and symptomatic
infections, hypoproteinemia, poor wound healing which in hernias which required surgical intervention (Fig. 1).
turn lead to increased perioperative morbidity and mortality. These patients had symptoms in the form of pain,
Though several indices have been proposed for estimating obstruction, large hernia with skin excoriation with
the risk in cirrhotic patients the child classification modified imminent rupture (Fig. 2).
by Pugh et al is the most widely accepted and commonly
used in practice. 5 Technique
The incidence of ventral hernia is high in patients with Preoperatively the patients were optimized with:
cirrhosis due to weak abdominal musculature and raised 1. Mannitol infusion
intra-abdominal pressure due to ascites. Umbilical hernias 2. Correction of prothrombin time with vitamin K and fresh
are more common due to transmission of additional pressure frozen plasma.
World Journal of Laparoscopic Surgery, May-August 2012;5(2):59-62 59