Amro Wafi, MD1, Archana Ramaswamy, MD, MBA2. 1University of Minnesota, Department of Surgery, 2Minneapolis VA Health Care System
Introduction: Surgery in the setting of decompensated liver disease carries significant morbidity and mortality. Abdominal wall hernia is a common problem in this population, especially in patients with refractory ascites. Frequently, hernia repair is performed on an emergent basis, which carries an even higher risk of morbidity and mortality. It’s generally accepted that preoperative management of ascites reduces risk of recurrence as well as morbidity and mortality. However, there is no standardized consensus on how to manage these patients post operatively. This study examines the utility of placing a temporary peritoneal dialysis catheter for postoperative management of ascites in improving outcomes.
Methods: A retrospective chart review of patients who underwent abdominal wall hernia repair at the Minneapolis VA between 1998 and 2015. Primary outcome measures included: hernia recurrence, wound complications, and 30-day mortality. Secondary outcome measures included: hospital length of stay and 3 year mortality. Standard statistical analysis was utilized using Chi-square tests and t test. P values < 0.05 were considered statistically significant.
Results: A total of 44 patients were identified with one female patient. 31 patients had a peritoneal dialysis catheter placed intraoperatively, and 13 patients underwent hernia repair without drain placement. Patients in the peritoneal dialysis catheter group were noted to have a higher MELD score (p=0.04) and a higher Child-Pugh score (p=0.007). Hernia repair was performed emergently in 64% of patients in the peritoneal dialysis catheter as opposed to 61% in the second group (p=0.85). There was no statistical difference between the two groups in terms of wound complications (p=0.06), hernia recurrence (p=0.08), and death at 30 days (p=0.83). The hospital length of stay was longer for patients in the peritoneal dialysis catheter group (p=0.04).
Conclusion: Patients with higher MELD or Child-Pugh score were more likely to have a peritoneal dialysis catheter placed at the time of the hernia repair. However, we did not find a statistical significant between the primary outcomes in the two groups. More work is needed to come up with a standardized way to treat patients with ascites following abdominal wall hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93332
Program Number: P589
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster