KẾT QUẢ NGẮN HẠN PHẪU THUẬT ĐIỀU TRỊ THOÁT VỊ RỐN Ở BỆNH NHÂN XƠ GAN CỔ TRƯỚNG

Abstract

Background: Umbilical hernia is defined as an abdominal wall herniation at or near the umbilicus. According to the European Hernia Society, the hernia location is within 3 cm above and below the umbilicus. The prevalence of umbilical hernia is approximately 2% of the population, with an increased incidence in patients with cirrhosis and obesity. About 20% of cirrhotic patients develop umbilical hernias. Patients with umbilical hernia and cirrhosis present with multiple systemic disorders, making surgical treatment challenging. The management of umbilical hernias in cirrhotic patients with ascites remains controversial, but early abdominal wall reconstruction surgery, before the onset of symptoms or complications, is increasingly accepted. Abdominal wall repair techniques include simple fascial closure and the use of synthetic mesh, either via an open or laparoscopic approach. However, in cirrhotic patients with ascites, open surgery remains predominant. Postoperative complications and mortality rates are significant concerns. Factors predicting postoperative complications and mortality play a crucial role in determining appropriate treatment strategies for each patient. Subjects – Methods: This is a retrospective case series study of 43 patients who underwent umbilical hernia repair in cirrhotic patients with ascites at Cho Ray Hospital from January 2018 to December 2022. Short-term postoperative outcomes during hospitalization were analyzed. Results: The majority of patients were male (79,1%), with a mean age of 56,9 ± 10,7 years (range: 27–79 years). All patients presented with an umbilical bulge. Incarcerated hernia and tenderness of the hernia mass were observed in 51,2% and 55,8% of cases, respectively. Hernia rupture occurred in 8 out of 43 cases (18,6%). The mean hernia size was 6,4 ± 5,1 cm (range: 2–30 cm). The mean Model for End-Stage Liver Disease (MELD) score was 16 ± 6,3, with decompensated cirrhosis accounting for 90,7% of cases. Emergency surgery was performed in 37 out of 43 cases (86%). All patients underwent open surgery, with primary fascial closure in 35 cases (81,4%), onlay mesh placement in 4 cases (9,3%), sublay mesh placement in 1 case (2,3%), and preperitoneal mesh placement in 3 cases (7%). The mean operative time was 93 ± 37,2 minutes (range: 50–200 minutes). The mean hospital stay was 7 ± 3,2 days (range: 2–17 days). Delayed return of bowel function was observed in patients with MELD scores ≥20 and those with medium-to-large hernia defects. Postoperative complications occurred in 13 cases (30%), with two deaths due to intra-abdominal hemorrhage and severe peritonitis (4,7%). Conclusion: Umbilical hernia is a common complication in cirrhotic patients with ascites. Surgical repair in these patients is associated with high postoperative complication and mortality rates, particularly in cases of delayed intervention, advanced cirrhosis, and MELD scores ≥20. Early diagnosis and surgical intervention are recommended to prevent life-threatening complications.