Licari L, Salamone G, Ciolino G, Campanella S, Parinisi Z, Sabatino C, Carfì F, Bonventre S, Gulotta G
G Chir. 2018 Jan-Feb;39(1):20-23. doi: 10.11138/gchir/2018.39.1.020.
The incidence of abdominal wall hernia in cirrhotic patients with ascites is between 20 and 40%. Controversies regarding the treatment modality and surgical timing of abdominal wall incisional hernia repair in cirrhotic patients remain. The study proposed wants to analyze the abdominal incisional hernia repair in cirrhotic patients with ascites performed in a single center to determine post-operative morbidity, mortality and complication rate.
Cirrhotic patients with abdominal incisional hernia that underwent surgical operation for abdominal wall hernia repair at the "Policlinico Paolo Giaccone" at Palermo University Hospital between January 2015 and December 2016 were identified and the data collected were retrospectively reviewed; patients' medical and surgical records were collected from charts and the surgical and ICU registries. The degree of hepatic dysfunction was classified using Child-Pugh classification. Post-operative mortality was considered up to 30-days after surgery. A follow-up period of 6 months at least was performed to evaluate hernia recurrence and complications.
Mortality rate is of 18.5% (p 0.002). Recurrence rate (p 0.004) and seroma formation rate (p 0.001) are most frequent in urgency group. The elevated ASA score and the prediction of a complicated post-operative course is higher in urgency group (p 0.004) as higher is the in-hospital stay (p 0.001) and the ICU stay (p 0.001).
Elective surgery for abdominal wall hernia repair in cirrhotic patients seems to be successful and associated with lower mortality/morbidity rate and recurrence rate than urgency.
肝硬化腹水患者腹壁疝的发生率在20%至40%之间。关于肝硬化患者腹壁切口疝修补的治疗方式和手术时机仍存在争议。本研究旨在分析在单一中心对肝硬化腹水患者进行的腹壁切口疝修补术，以确定术后发病率、死亡率和并发症发生率。
确定2015年1月至2016年12月期间在巴勒莫大学医院“保罗·贾科内综合医院”接受腹壁疝修补手术的肝硬化腹壁切口疝患者，并对收集的数据进行回顾性分析；从病历以及手术和重症监护病房登记处收集患者的医疗和手术记录。使用Child-Pugh分类法对肝功能障碍程度进行分类。术后死亡率计算至术后30天。至少进行6个月的随访，以评估疝复发和并发症情况。
死亡率为18.5%（p = 0.002）。急诊组的复发率（p = 0.004）和血清肿形成率（p = 0.001）最高。急诊组的ASA评分升高以及术后病程复杂的预测率更高（p = 0.004），住院时间（p = 0.001）和重症监护病房停留时间（p = 0.001）也更长。
肝硬化患者择期进行腹壁疝修补手术似乎是成功的，与急诊手术相比，其死亡率/发病率和复发率更低。
