Inguinal hernioplasty in patients with cirrhosis and ascites: what preventive measures are needed for a safe procedure?

Abstract

BACKGROUND: Inguinal hernioplasty in patients with LC and ascites has been long discouraged for the incidence of postoperative complications. The aim is to evaluate the appropriateness of this elective surgical procedure in patients with LC and ascites.

METHODS: Thirty consecutive LC patients with ascites and affected by inguinal hernia (LC group), who underwent elective open inguinal hernioplasty with mesh placement, have been matched with the same number of patients non-LC (non-LC group) who underwent the same surgical procedure in the same period of time. All patients in LC group received a careful hepatological assessment and were classified according to the etiology of LC and to the Childs class.

Patients of both groups received an antibiotic prophylaxis and were operated under local anesthesia.

RESULTS: No significant complications were observed in any patients during surgery. The hospital stay was significantly longer in LC group. During the postoperative time, 4 inguinoscrotal hematoma appeared in LC group, of which 3 in class C (LC VS non-LC p>0.05; non-LC VS Childs class C p<0.023). Ascites leakage or wound infection were not observed.

CONCLUSION: Inguinal hernioplasty can be safely performed for LC patients in Childs class A and B; for patients in class C, careful attention must be paid to the hemorrhagic events.