Background: Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites, having a tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge. Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, mesh repair is associated with lower recurrence rate, but with higher surgical site infection when compared to conventional fascial suture. Intraperitoneal mesh repair has advantages of avoiding recurrence, decreasing ascetic leak and wound infection.
Objective: The purpose of this study was to compare the safety and effectiveness of surgical management of umbilical and paraumbilical hernia via anatomical repair and intraperitoneal mesh repair in relation to conservative treatment in ascetic patients.
Patients and methods: This randomized controlled study included 94 patients presented with umbilical and paraumbilical hernia with ascites. The study was conducted in Mansoura University Hospitals through the period from 2016 to 2018. The patients were divided randomly into 3 groups; Conservative treatment group (28 cases), anatomical repair group (36 cases) and intraperitoneal mesh repair via composite mesh group (30 cases). Comparison was done for effectiveness and complications.
Results: Conservative treatment had high rate of complications (60%) and deterioration of hepatic condition (18%), elective surgical correction appeared more safe, intraperitoneal composite mesh repair decreased leak and significantly reduced recurrence and associated complications compared to anatomical repair (17% versus 3%).
Conclusion: Both elective anatomical repair and intraperitoneal mesh repair of umbilical and paraumbilical hernia in ascetic patients were safer and better than conservative treatment. Intraperitoneal mesh repair has advantages of avoiding recurrence and decreasing ascetic leak.