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The abdominal wall hernia in cirrhotic patients: a historical challenge
BACKGROUND: The incidence rate of abdominal wall hernia is 20–40% in cirrhotic patients. A surgical approach was originally performed only if complication signs and symptoms occurred. Several recent studies have demonstrated the usefulness of elective surgery. During recent decades, the indications...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064098/ https://www.ncbi.nlm.nih.gov/pubmed/30065783 http://dx.doi.org/10.1186/s13017-018-0196-z |
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author | Salamone, Giuseppe Licari, Leo Guercio, Giovanni Campanella, Sofia Falco, Nicolò Scerrino, Gregorio Bonventre, Sebastiano Geraci, Girolamo Cocorullo, Gianfranco Gulotta, Gaspare |
author_facet | Salamone, Giuseppe Licari, Leo Guercio, Giovanni Campanella, Sofia Falco, Nicolò Scerrino, Gregorio Bonventre, Sebastiano Geraci, Girolamo Cocorullo, Gianfranco Gulotta, Gaspare |
author_sort | Salamone, Giuseppe |
collection | PubMed |
description | BACKGROUND: The incidence rate of abdominal wall hernia is 20–40% in cirrhotic patients. A surgical approach was originally performed only if complication signs and symptoms occurred. Several recent studies have demonstrated the usefulness of elective surgery. During recent decades, the indications for surgical timing have changed. METHODS: Cirrhotic patients with abdominal hernia who underwent surgical operation for abdominal wall hernia repair at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2010 and September 2016 were identified in a prospective database, and the data collected were retrospectively reviewed; patients’ medical and surgical records were collected from charts and surgical and intensive care unit (ICU) registries. Postoperative morbidity was determined through the Clavien-Dindo classification. Cirrhosis severity was estimated by the Child-Pugh-Turcotte (CPT) score and MELD (model of end-stage liver disease) score. Postoperative mortality was considered up to 30 days after surgery. A follow-up period of at least 1 year was used to evaluate hernia recurrence. RESULTS: The univariate and multivariate analyses demonstrated the unique independent risk factors for the development of postsurgical morbidity (emergency surgery (OR 6.42; p 0.023), CPT class C (OR 3.72; p 0.041), American Society of Anesthesiologists (ASA) score ≥ 3 (OR 4.72; p 0.012) and MELD ≥ 20 (OR 5.64; p 0.009)) and postsurgical mortality (emergency surgery (OR 10.32; p 0.021), CPT class C (OR 5.52; p 0.014), ASA score ≥ 3 (OR 8.65; p 0.018), MELD ≥ 20 (OR 2.15; p 0.02)). CONCLUSIONS: Concerning abdominal wall hernia repair in cirrhotic patients, the worst outcome is associated with emergency surgery and with uncontrolled disease. The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction. |
format | Online Article Text |
id | pubmed-6064098 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-60640982018-07-31 The abdominal wall hernia in cirrhotic patients: a historical challenge Salamone, Giuseppe Licari, Leo Guercio, Giovanni Campanella, Sofia Falco, Nicolò Scerrino, Gregorio Bonventre, Sebastiano Geraci, Girolamo Cocorullo, Gianfranco Gulotta, Gaspare World J Emerg Surg Research Article BACKGROUND: The incidence rate of abdominal wall hernia is 20–40% in cirrhotic patients. A surgical approach was originally performed only if complication signs and symptoms occurred. Several recent studies have demonstrated the usefulness of elective surgery. During recent decades, the indications for surgical timing have changed. METHODS: Cirrhotic patients with abdominal hernia who underwent surgical operation for abdominal wall hernia repair at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2010 and September 2016 were identified in a prospective database, and the data collected were retrospectively reviewed; patients’ medical and surgical records were collected from charts and surgical and intensive care unit (ICU) registries. Postoperative morbidity was determined through the Clavien-Dindo classification. Cirrhosis severity was estimated by the Child-Pugh-Turcotte (CPT) score and MELD (model of end-stage liver disease) score. Postoperative mortality was considered up to 30 days after surgery. A follow-up period of at least 1 year was used to evaluate hernia recurrence. RESULTS: The univariate and multivariate analyses demonstrated the unique independent risk factors for the development of postsurgical morbidity (emergency surgery (OR 6.42; p 0.023), CPT class C (OR 3.72; p 0.041), American Society of Anesthesiologists (ASA) score ≥ 3 (OR 4.72; p 0.012) and MELD ≥ 20 (OR 5.64; p 0.009)) and postsurgical mortality (emergency surgery (OR 10.32; p 0.021), CPT class C (OR 5.52; p 0.014), ASA score ≥ 3 (OR 8.65; p 0.018), MELD ≥ 20 (OR 2.15; p 0.02)). CONCLUSIONS: Concerning abdominal wall hernia repair in cirrhotic patients, the worst outcome is associated with emergency surgery and with uncontrolled disease. The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction. BioMed Central 2018-07-28 /pmc/articles/PMC6064098/ /pubmed/30065783 http://dx.doi.org/10.1186/s13017-018-0196-z Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Salamone, Giuseppe Licari, Leo Guercio, Giovanni Campanella, Sofia Falco, Nicolò Scerrino, Gregorio Bonventre, Sebastiano Geraci, Girolamo Cocorullo, Gianfranco Gulotta, Gaspare The abdominal wall hernia in cirrhotic patients: a historical challenge |
title | The abdominal wall hernia in cirrhotic patients: a historical challenge |
title_full | The abdominal wall hernia in cirrhotic patients: a historical challenge |
title_fullStr | The abdominal wall hernia in cirrhotic patients: a historical challenge |
title_full_unstemmed | The abdominal wall hernia in cirrhotic patients: a historical challenge |
title_short | The abdominal wall hernia in cirrhotic patients: a historical challenge |
title_sort | abdominal wall hernia in cirrhotic patients: a historical challenge |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064098/ https://www.ncbi.nlm.nih.gov/pubmed/30065783 http://dx.doi.org/10.1186/s13017-018-0196-z |
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