Herniorrhaphy of umbilical hernia with ascites / 中华普通外科杂志

ABSTRACT

Objective To discuss the control of ascites, timing and skill of herniorrhaphy for the treatment of umbilical hernia with ascites. Methods The management of 21 patients of umbilical hernia with ascites were retrospectively analyzed. Preoperative small amount of ascites was managed with oral diuretics, medium amount of ascites was treated with combined oral and intravenous diuretics, refractory ascites was treated with paracentensis (3000 ml each time). In the meantime, intravenous albumin, dopamine and fluid therapy were administered. In relapsing ascites, repeated paracentensis in a time interval of 2-4 days was applied. It was time for surgery when abdominal wall tension ameliorated, abdominal circumference reduced and the hernia sac shrank. In case of ascites refractory to all preoperative management an intraoperative slow extraction of the ascites to the amount below 4000 mi is mandatory. Perioperative diuretic therapy is the key for a successful herniorrhaphy. There were 21 cases in our group, 19 cases underwent selective operation, 2 cases were treated with emergency operation; 20 cases by tension-free hernia repair, 1 case by suture herniorrhaphy. Results Surgery was successful in all patients, the mean operative time was 45 min (25-90 min). During the follow-up period from 2 to 52 months (meanly 23 months), only 1 case lost and the other 19 cases healed with no recurrence. 20 patients healed well with no hernia recurrence or complications. One case who was treated with suture hemiorrhaphy suffered from incisional infection, and died of hepatic failure 3 weeks after surgery. Conclusions Umbilical hernia with ascites is not an absolute surgical contraindication. By intensive management of the ascites in perioperative period and prudent selection of the timing of surgery, tension-free herniorrhaphy is a safe and effective treatment for umbilical hernia.