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Laparoscopic abdominal drainage in treatment of abdominal wall hernia in cirrhotic patients accompanied by ascites.

Gheorghe Anghelici, PhD, Profesor, Sergiu Pisarenco, Md, Tatiana Zugrav, Md. State University of Medicine and Pharmacy “Nicolae Testemitanu”

Background: Management of abdominal wall hernias in cirrhotic patients accompanied by ascites is still under debate. The objective of this study was to compare the outcome in our series of urgently versus scheduled operated treatment of these patients.

Methods: In the period between 2012 and 2016, 102 patients with an abdominal wall hernia combined with liver cirrhosis and ascites were identified from our hospital database.

I group: 48 cirrhotic patients operated on urgently, including 36 (75%) – with hernia sac erupts with ascites fluid overflow and 12 (25%) with strangulated hernias. 9 (18.8%) patients was performed endoscopic hemostasis simultaneously for variceal bleeding. In 55% cases ascites fluid was present bacterial microflora.

Group II: 54 cirrhotic patients with massive ascites and spontaneous eruption risk of hernia, operated scheduled after a thorough preoperative preparation, laporoscopic drainage of abdominal ascites and abdominal cavity lavage with antibacterials. In 85% cases ascites fluid was present bacterial microflora.

Plasty method – "tension-free no mesh" with Platelet-rich fibrin application. Sealing prophylactic endoscopic variceal was performed in 29 (53.7%) patients.

Conclusions: Patients with  leaver cirrhosis with massive resistance ascites should be operated in a planned way for hernia anterior abdominal wall. In this cases its obligatory the endoscopic exam for prevention of variceal bleeding.  The priority has the procedures „tension  free no mesh” or „tension  free no mesh” with Platelet-rich fibrin application. Laparoscopic abdominal drainage and lavage with antibacterials reduces the risk of ascites-peritonitis, improves wound healing.  Drain of abdominal cavity in post operatory period decrease the risk of developing the ascites peritonitis and improve the wound healing.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87960

Program Number: P016

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

90

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