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Invited Critique
Sep 2012

Should a Patient With Cirrhosis Have an Innie or an Outie?

Arch Surg. 2012;147(9):869-870. doi:10.1001/archsurg.2012.2031

Umbilical hernias in patients with cirrhosis are a difficult problem in high-risk patients, and every surgeon has his or her own nightmare of a bad umbilical hernia case. Few surgeons want to fix these hernias, much less write about their experience. As a result, studies are limited. Cho et al1 analyzed data from the National Surgical Quality Improvement Program (NSQIP) database on umbilical hernia repairs in patients with ascites or varices as a surrogate for cirrhosis. The 390 patients studied were older and had more chronic obstructive pulmonary disease, cardiac disease, diabetes mellitus, hypertension, steroid use, smoking, and sepsis before surgery. The group had higher morbidity and mortality, which may have been due to the other comorbidities. Perhaps a case-control study to account for other comorbidities would have better delineated the effect of the liver disease on hernia outcome.