Elective surgical repair of groin hernias with mesh versus herniorraphy in ascitic liver patients

ABSTRACT

To initially evaluate the possibility of electively repairing groin hernias in ascitic liver patients, to test the feasibility of the use of mesh in these patients and to evaluate mesh repair versus herniorraphy, 30 patients' [3 females and 27 males] with liver ascites and uncomplicated groin hernias were treated operatively for their hernias. They were divided into two groups group I [Gp I] 14 patients [9 indirect, 3 direct and 2 femoral] treated by herniorraphy and group II [Gp II] 16 patients [10 indirect, 3 direct, 3 femoral] treated by polypropylene mesh placement with or without plug. All operations were performed under local anesthesia with preoperative prophylactic antibiotic cover. 23 patients were followed up 11 in Gp I [4 to 24 months mean = 14.82 SD, 6.08] and 12 in group II [7 to 28 months mean = 14.42 SD, 5 98] Seventeen ascitic fluid samples were taken intra-operatively for bacteriological study. There was no operative mortality. Post operative complications included temporary increase in ascites which occurred in 25 patients [12 in group [I], 13 group[II]]. In 21 cases. It responded to medical treatment and in three it required paracentesis. There was no deep wound infection. There were three cases of superficial wound infection [2 in group I and one in group II]. Scrotal hematoma and/or seroma occurred in four cases. A major attack of variceal bleeding occurred in a patient in the mesh group and was treated successfully. There was no spontaneous bacterial peritonitis. There were three recurrences two in Gp I and one in Gp II. two of the recurrences were attributed to technical mistakes. Five [29.41%] of the bacteriological samples showed mono-microbial organisms i.e. bacterascites. Three were gram-ve two of them were E coli and one Pantoea spp. and two were Gram +ve Staph aureus [one was methicillin resistant] Findings indicate that elective groin hernia repair in liver patients with ascites is feasible even without prior peritoneovenous shunting with no mortality and an acceptable overall rate of complication. The use of mesh seems justified in -those patients with comparable of not superior, results to herniorraphy. Mesh placement was not associated with any increase in the rate of complications or wound infection .Although no spontaneous bacterial peritonitis occurred in this .study, caution should be taken and long antibiotic cover is probably important to avoid this fatal complication because bacterascites was found in 29 41% of the patients