A New Modified Technique In Complicated Umbilical Hernia Repair In Patients With Decompensated Cirrhosis: A Single Center Experience

Background Patients with decompensated cirrhosis have a high incidence of abdominal wall hernias with a poor outcome after surgical management. Aim The aim was to evaluate the outcome of a new technique in the repair of complicated umbilical hernias in patients with decompensated cirrhosis. Patients and methods In all, 30 consecutive patients with decompensated cirrhosis underwent herniorrhaphy for complicated hernia and were randomized into two groups: group I (n=15) received the new technique: three-transverse-layer technique with regular paracentesis, first, 5-7 interrupted sutures without tie; second, continuous suture starting 3 cm lateral to the angles, third, tie the previous interrupted suture over the continuous tied suture, fourth, the third layer continuous suture to invaginate the previous sutures (using Proline 1/0 at all), fifth, regular paracentesis. Group II (n=15) received two continuous transverse-layer repair, first, suture started 1 cm lateral to the angle and then completed in a continuous manner till 1 cm after the second angle and tied; second, this was then followed by the second layer continuous suture to invaginate the previous sutures. Results Postoperatively, there were complications in 14 (46.67%) patients in the form of wound infection in three (20%) patients in group I and seven (46.67%) patients in group II with no statistical significance between both groups. Wound dehiscence occurred in five (33.33%) patients in group II only with statistical significance between both groups (P<0.05). Wound leakage also occurred in eight (53.33%) patients of group II with statistical significance between both groups (P<0.05). During the follow-up after 6 months and 1 year, the overall recurrence showed statistical significance regarding the new modified technique. Conclusion The new technique of hernia repair in patients with decompensated liver cirrhosis was associated with a significant reduction in wound ascitic leak, wound dehiscence, hospital stay, morbidity, and recurrence.