Umbilical hernia repair in patients with cirrhosis. No evidence for increased incidence of variceal bleeding.

Umbilical hernias are common in patients with alcoholic cirrhosis. Often elective repair is delayed for fear of precipitating acute variceal bleeding by interruption of portal--systemic venous collaterals. In order to test this hypothesis, the incidence of variceal bleeding following repair of umbilical hernia was determined retrospectively in 22 consecutive patients from our hospital and 74 others from six reports in the literature. Overall the perioperative (less than 3 months postrepair) incidence of variceal bleeding was 11%. This incidence of bleeding was equal to the incidence of bleeding reported in the literature in a group of cirrhotics with varices who did not undergo surgery. In addition, no correlation was seen between patients with a preoperative history of varices or bleeding and those who bled after surgery. Therefore, surgical repair of umbilical hernia can be performed in these patients without additional risk of precipitating variceal bleeding.