Hernias and Patients with Ascites

Abstract

The presence of ascites increases the incidence of hernias in general and umbilical hernias in particular. It greatly complicates the decision-making process necessary to provide optimal care. Ascites may be seen in conditions such as chronic renal disease, congestive heart failure, or massive fluid overload, but it is more often related to intraabdominal factors that lead to the formation of peritoneal fluid at a more rapid rate than that at which it can be absorbed. These conditions are malignancies, tuberculosis, pancreatitis, acute liver diseases, and chronic liver diseases, which are by far the most common causes of ascites. The problem of abdominal hernias and, in particular, umbilical hernias in patients with ascites concerns almost exclusively patients with cirrhosis. In these patients, chronic increased intraabdominal pressure as well as muscular wasting, a consequence of malnutrition, are thought to be the main predisposing factors to umbilical hernia development. Incisional hernias and groin hernias are seen less frequently in cirrhotic patients than umbilical hernias. Whereas umbilical herniorrhaphy of an uncomplicated hernia in patients without ascites can be performed with low mortality and morbidity, cirrhotic patients with ascites bear a higher risk of complications before and after operation. There, the treatment of ascites appears to be a major determinant of prognosis.