Mesh repair of non-complicated umbilical hernia in ascitic patients with liver cirrhosis.

The policy of elective repair of umbilical hernia in cirrhotic ascitic patients has long been a subject of debate and is still a major health problem. This study evaluated the role and outcome of elective mesh repair of umbilical hernia in cirrhotic ascitic patients, compared with the conventional two layers fascial repair technique. Forty cases with a small to medium sized umbilical hernia defects in ascitic cirrhotic patients were divided into two groups (GI & GII) of 20 patients each. After proper control of ascites in both groups, patients in GI were subjected to elective umbilical hernia onlay mesh repair. In GII, hernias were managed by conventional two layers fascial repair. In GI, transient early postoperative ascitic fluid leakage occurred in 3 (15%) cases and mild superficial wound infection in 5 (25%) cases which was controlled by antibiotics. Two (10%) cases developed hernia recurrence during follow up period. In GII, ascitic leakage occurred in 6 (30%) cases that responded well to conservative management except only one case needed re-exploration and repair reenforcement. Drainage was significantly less than in GI in amount (P<0.05) and duration (P<0.01), wound infection occurred in 3 (15%) cases but were superficial and controlled conservatively. Recurrence occurred in 7 cases (35%). Elective mesh repair of umbilical hernia with ascites in cirrhotic patients proved to be a safe, simple and effective technique with perioperative antibiotics and proper aseptic procedure.