Natural history of repaired umbilical hernias in patients with and without ascites.

A retrospective chart review was undertaken to determine the natural history of repaired umbilical hernias in patients with and without a history of ascites. Eighty-five patients underwent umbilical herniorrhaphy during the interval from January 1973 to March 1983. The length of hospital stay was significantly longer for the 22 patients who had a history of ascites; however, the complication rate of elective repair of umbilical hernias that were caused by ascites was not different from that of the 63 patients without a history of ascites. There was no operative mortality in either group. Sixty-eight patients were reevaluated at least 1 month postoperatively. Of the 51 patients who had never had ascites, six (12%) developed a recurrent hernia. Of the 17 patients whose hernias were caused by ascites, eight (47%) developed recurrences. Of the 11 herniorrhaphies performed when ascitic fluid was present, eight (73%) resulted in a recurrence, whereas only one (17%) patient had a recurrence among the group of seven patients who underwent herniorrhaphy at a time when the ascitic fluid was no longer present. Umbilical hernias caused by ascites can be repaired with acceptable morbidity and probably should be repaired after the fluid has been medically removed.