Umbilical and Incisional Hernias in Liver Cirrhosis Patients: A Potentially Life-Threatening Condition

Introduction: Hernia surgery in cirrhotic patients can represent a life threatening condition. The aim of the study is to analyze the outcome of these patients in order to propose a modification of the MELD criteria for the liver transplantation waiting list.

Material and Methods: Seventeen patients with cirrhosis (13 Child A and B, 4 Child C) and abdominal wall hernia (9 umbilical, 5 incisional, 3 inguinal hernias) that underwent elective (10 cases) or emergency (7 cases) surgery in our Institution, have been retrospectively studied. Hepatocellular carcinoma has been present in 7 cases.

Results: Mortality have been null among Child A and B patients and it has been of the 100% among Child C patients with umbilical or incisional hernia (p ≤ 0.0004). All the patients with hepatocellular carcinoma and Child C died (mortality 100%). (p value result of comparison with Child A and B stages patients has been: 0,0286).

Conclusion: These data suggest us to propose a modification of the MELD exceptions criteria P1 to organ allocation model for Child C patients that underwent emergency umbilical or incisional hernia. Also patients with hepatocellular carcinoma, Child C cirrhosis that underwent elective surgery for umbilical and incisional hernia could obtain extra-points in the waiting list prioritization.

Keywords: umbilical hernia, liver cirrhosis, herniorrhaphy, hepatocellular carcinoma, liver transplant MELD.