SURGICAL MANAGEMENT OF ABDOMINAL HERNIA IN CIRRHOTIC PATIENTS

In patients with liver cirrhosis, abdominal parietal hernias have a significantly higher prevalence than in the general population (20-40%), due to the presence of ascites, but also to a combination of factors that these patients are presenting: increased intra-abdominal pressure, weakness of muscle and of the fascial structures of the abdominal wall, on the background of poor nutrition, poor status and post-surgical scars. The aim of our approach is to try to outline an optimal surgical protocol for the parietal defects of the cirrhotic, both from an ethical and strategic point of view, starting with the stage of cirrhosis or with the clinical presentation of the patients, taking into account our own experience, with the review data from the specialized literature. In a retrospective study, the last 100 patients with liver cirrhosis operated in our clinic between 2015 and 2024 included 65 male and 35 female, aged between 45 and 70 years (on average 57 years). The etiology of liver cirrhosis was represented by chronic ethanol consumption for 63 cases and viral infection (B or C) for 37 cases. Laboratory data (albuminemia, bilirubinemia, prothrombin time) and clinical data (presence of ascites or encephalopathy) were used to classify cirrhosis in the Child-Pugh classification, and the information related to the type of hernia, the nature of the surgical indication (emergency or elective), the technique surgical procedure and postoperative evolution were collected from the observation sheets. Analyzing our results, in accordance with those internationally achieved, some elements are defined to influence the results of hernia surgery in cirrhotic patients: the presence of ascites, the stage of cirrhosis evolution, the surgical technique used and the elective/emergency nature of the intervention. The parietal defects of cirrhotic patients can be approached surgically with satisfactory results. The most effective are the scheduled interventions, performed in the compensated stages of cirrhosis. The surgical technique uses both classical and alloplastic methods. Conservative management is indicated in cases of uncomplicated hernia and in the decompensated stages of the disease.