Page 6 - Journal of WALS

Bharati V Hiremath et al

All patients were optimized preoperatively with mannitol previous studies for similar situation. However, unlike these
and correction of coagulation defects. studies which were in patients with child A cirrhosis our
Ascitic leak was overcome by the use of a dual mesh. patients were those with child C cirrhosis. To the best of
It is a soft polypropylene mesh encapsulated with our knowledge, this is the first study reported for patients
polydiaxone (PDS) and oxidized regenerated cellulose with child’s cirrhosis.
(ORC) which is a plant material and helps to minimize tissue Though we selected only patients with complicated
attachment. The absorbable PDS creates a flexible and hernias, our results encourage us to advocate this procedure
secure bond between the mesh and the ORC layers. This for prophylactic repair of ventral hernias in all cirrhotic
helps to effectively separate the mesh from the underlying patients with tense ascites.
viscera. It also has the added advantage of not harboring
bacteria and reduces the chances of mesh infection to REFERENCES
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Infection was prevented by strict asepsis during the Philadelphia; WB Saunders 1964.
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8. Fitzgibbons RJ, Greenburg AG. Nyhus and Condon’s Hernia.
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umbilical hernia in ascitic patients with liver cirrhosis. J Egypt
In all patients the ascitic fluid recollected back within Soc Parasitol 2007;37(3 Suppl):1189-97.
48 hours, to the preoperative volume. However, none of 10. Good DW, Royds JE, Smith MS, et al. Umblical hernia rupture
them had ascetic leak through the operative site. None of with evisceration of omentum from massive ascites. J Med Case
the patients had wound infection. There were no recurrences Rep 2011;5:170.
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One patient with Budd-Chiari syndrome had postoperative 12. Jitea N, et al. Umblical hernia in adults: Laparoscopic approach
bleeding from the wound edges resulting in hematoma with prolene mesh—is it a safe procedure? Chirurgia (Bucht)
formation. This patient was on oral anticoagulants which 2008;103(2):175-79.
was stopped and converted to intravenous heparin in the
preoperative, intraoperative and 24 hours postoperative ABOUT THE AUTHORS
period. The hematoma was evacuated and the wound was Bharati V Hiremath
dressed with a Botroclot (aqueous solution of hemoco-
agulase isolated from Bothrops atrox) soaked dressing. Professor, Department of General Surgery, MS Ramaiah Hospital
Bengaluru, Karnataka, India
There was no further recurrence of hematoma. One patient
had a seroma in the region of the umbilicus which was Nitin Rao
managed conservatively.
Associate Professor, Gastroenterologist, Department of Surgical
Gastroenterology, MS Ramaiah Hospital, Bengaluru, Karnataka, India
CONCLUSION
Our study has shown that laparoscopic repair of ventral Bharathi Raja
hernia in cirrhotic patients with tense ascites is technically Postgraduate Student (Final Year), Department of General Surgery
feasible and safe. Our study is comparable with the two MS Ramaiah Hospital, Bengaluru, Karnataka, India

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