Petrič Miha, Plevel Danaja, Tršan Uroš, Trotovšek Blaž
Department of Abdominal Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia.
Medicina (Kaunas). 2025 Jul 12;61(7):1262. doi: 10.3390/medicina61071262.
. Umbilical hernia is particularly common among patients with liver cirrhosis, affecting about 20% of this group, compared to 3-8.5% in healthy individuals. This increased prevalence is mainly due to weakened abdominal fascia, elevated intra-abdominal pressure, and malnutrition. The rapid progression of umbilical hernias often leads to complications such as skin necrosis, perforation, and strangulation. Historically, patients with liver cirrhosis and complicated umbilical hernia have faced high morbidity and mortality rates. However, recent advancements in perioperative management, especially in controlling ascites, have improved outcomes in elective treatments. Despite these advancements, managing patients with decompensated liver cirrhosis and complicated umbilical hernia in emergency settings remain a significant surgical challenge. : We conducted a retrospective review of patients treated for complicated umbilical hernia at the University Medical Centre Ljubljana from 2015 to 2024, using prospectively collected data. This analysis involved implementing hernioplasty combined with incisional negative pressure wound therapy (iNPWT) as part of the surgical protocol. The primary endpoint of our study was the rate of local complications, while the secondary endpoints included the rate of systemic complications and 90-day mortality. : We treated 28 consecutive patients with complicated umbilical hernia and liver cirrhosis. Local wound complications were observed in three (10.7%) patients. Systemic complications developed in 10 patients (35.7%). The median duration of hospitalization was 8 days (range: 5-29), and no readmissions were recorded within the 30-day period. Two (7.1%) patients died within 90 days. : Our experience indicates that iNPWT, when combined with surgical repair, can be safely utilized, yielding outcomes comparable to elective hernia repairs, even in emergency contexts. Further randomized controlled trials are necessary to validate these findings and optimize treatment protocols.
脐疝在肝硬化患者中尤为常见，该群体中约20%受其影响，而健康个体中的发生率为3 - 8.5%。这种患病率的增加主要归因于腹壁筋膜薄弱、腹内压升高和营养不良。脐疝的快速进展常导致皮肤坏死、穿孔和绞窄等并发症。从历史上看，肝硬化合并脐疝的患者面临着较高的发病率和死亡率。然而，围手术期管理的最新进展，尤其是在控制腹水方面，改善了择期治疗的效果。尽管有这些进展，但在急诊情况下管理失代偿期肝硬化合并脐疝的患者仍然是一项重大的外科挑战。我们对2015年至2024年在卢布尔雅那大学医学中心接受复杂脐疝治疗的患者进行了回顾性研究，使用前瞻性收集的数据。该分析涉及将疝修补术与切开负压伤口治疗（iNPWT）作为手术方案的一部分实施。我们研究的主要终点是局部并发症的发生率，次要终点包括全身并发症的发生率和90天死亡率。我们连续治疗了28例复杂脐疝合并肝硬化的患者。3例（10.7%）患者出现局部伤口并发症。10例患者（35.7%）发生全身并发症。中位住院时间为8天（范围：5 - 29天），30天内无再入院记录。2例（7.1%）患者在90天内死亡。我们的经验表明，iNPWT与手术修复相结合时可以安全使用，即使在急诊情况下，其效果也与择期疝修补术相当。需要进一步的随机对照试验来验证这些发现并优化治疗方案。
