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| 1 | Successful surgical management of ruptured umbilical hernias in cirrhotic patients显示文摘Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual,but potentially lifethreatening complication,with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical repair.Management options include primary surgical repair with or without concomitant portal venous system decompression for the control of the ascites.We present a retrospective analysis of our centre's experience over the last 6 years.Our cohort consisted of 11 consecutive patients(median age:53 years,range:36-63 years) with advanced hepatic cirrhosis and refractory ascites.Appropriate patient resuscitation and optimisation with intravenous fluids,prophylactic antibiotics and local measures was instituted.One failed attempt for conservative management was followed by a successful primary repair.In all cases,with one exception,a primary repair with non-absorbable Nylon,interrupted sutures,without mesh,was performed.The perioperative complication rate was 25% and the recurrence rate 8.3%.No mortality was recorded.Median length of hospital stay was 14 d(range:4-31 d).Based on our experience,the management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible without the use of transjugular intrahepatic portosystemic shunt routinely in the preoperative period,provided that meticulous patient optimisation is performed. | Nikolaos A Chatzizacharias J Andrew Bradley Simon Harper Andrew Butler Asif Jah Emmanuel Huguet Raaj K Praseedom Michael Allison Paul Gibbs | 2015 | World Journal of Gastroenterology2015，21，10： | 4 |
| 2 | Outcomes of abdominal surgery in patients with liver cirrhosis显示文摘Patients suffering from liver cirrhosis(LC) frequently require non-hepatic abdominal surgery,even before liver transplantation.LC is an important risk factor itself for surgery,due to the higher than average associated morbidity and mortality.This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors,such as coagulopathy,poor nutritional status,adaptive immune dysfunction,cirrhotic cardiomyopathy,and renal and pulmonary dysfunction,which all lead to poor outcomes.Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery.In the emergency setting,with the presence of decompensated LC,alcoholic hepatitis,severe/advanced LC,and significant extrahepatic organ dysfunction conservative management is preferred.A multidisciplinary,individualized,and specialized approach can improve outcomes;preoperative optimization after risk stratification and careful management are mandatory before surgery.Laparoscopic techniques can also improve outcomes.We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before,during,and after surgery. | Juan C Lopez-Delgado Josep Ballus Francisco Esteve Nelson L Betancur-Zambrano Vicente Corral-Velez Rafael Manez Antoni J Betbese Joan A Roncal Casimiro Javierre | 2016 | World Journal of Gastroenterology2016，22，9： | 0 |
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