Feasibility exploration of day surgery for inguinal hernia combined with cirrhotic ascites_West China Medical Journal

Authors：

NING Pengtao , WANG Quan , GAO Boxin , TIAN Xiaohe ,  LIU Xiaonan

Day Surgery Center, Xijing Hospital, the First Affiliated Hospital of the Air Force Military Medical University, Xi’an, Shaanxi 710032, P. R. China;

Corresponding author：

LIU Xiaonan, Email: liuxnxjh@163.com

Keywords：

Inguinal hernia; cirrhosis; ascites; day surgery

DOI：

10.7507/1002-0179.202411309

Video：

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Objective To explore the feasibility of inguinal hernia repair in patients with cirrhotic ascites under day surgical mode. Methods The clinical data of patients undergoing elective inguinal hernia repair with concurrent cirrhotic ascites under the day surgical mode admitted to Xijing Hospital, the First Affiliated Hospital of the Air Force Military Medical University between December 2015 and March 2023 were retrospectively analyzed. The diagnosis, treatment, and postoperative conditions of the patients were analyzed and summarized. Results Ultimately, 8 patients undergoing elective inguinal hernia repair with concurrent cirrhotic ascites under day surgical mode were included. Some patients had bilateral hernias, with a total of 11 cases of hernias. All of these hernias were oblique hernias, including 1 case of recurrent hernia. The surgical methods for 10 cases of hernia were Lichtenstein surgery, and 1 case used laparoscopic retroperitoneal hernia repair. All 8 patients did not use antibiotics during the perioperative period. Only 1 case of recurrent inguinal hernia occurred after surgery. Another patient was admitted to liver disease specialist ward due to ascites, and later improved. No patients experienced serious complication or surgery related death. Conclusions Under the premise of effectively improving complications of cirrhosis, patients with stable cirrhotic ascites who have undergone strict screening can undergo inguinal hernia repair surgery under the day surgical mode. However, further large-scale studies are needed in the future to clarify their specific application conditions and indications for the use of antibiotic.

Citation： NING Pengtao, WANG Quan, GAO Boxin, TIAN Xiaohe, LIU Xiaonan. Feasibility exploration of day surgery for inguinal hernia combined with cirrhotic ascites. West China Medical Journal, 2025, 40(2): 188-193. doi: 10.7507/1002-0179.202411309 Copy

1.	Li J, Qin C, Lai D, et al. Safety and effectiveness of inguinal hernia repair in patients with liver cirrhosis: a retrospective study and literature review. Hernia, 2020, 24(3): 489-494.
2.	Hur YH, Kim JC, Kim DY, et al. Inguinal hernia repair in patients with liver cirrhosis accompanied by ascites. J Korean Surg Soc, 2011, 80(6): 420-425.
3.	Johnson KM, Newman KL, Green PK, et al. Incidence and risk factors of postoperative mortality and morbidity after elective versus emergent abdominal surgery in a national sample of 8193 patients with cirrhosis. Ann Surg, 2021, 274(4): e345-e354.
4.	Hansen JB, Thulstrup AM, Vilstup H, et al. Danish nationwide cohort study of postoperative death in patients with liver cirrhosis undergoing hernia repair. Br J Surg, 2002, 89(6): 805-806.
5.	Oh HK, Kim H, Ryoo S, et al. Inguinal hernia repair in patients with cirrhosis is not associated with increased risk of complications and recurrence. World J Surg, 2011, 35(6): 1229-1233.
6.	杨世炜, 王永, 伍兵, 等. 无张力疝修补术治疗腹股沟疝合并腹腔积液的临床疗效. 中华消化外科杂志, 2017, 16(9): 911-914.
7.	李瑛, 胡振斌, 徐昆, 等. 中医药治疗肝硬化腹水临床研究概述. 中西医结合肝病杂志, 2022, 32(2): 185-188.
8.	Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology, 2021, 74(2): 1014-1048.
9.	张传宝, 张敬坡, 冯雷, 等. 局部神经阻滞麻醉下无张力疝修补术在肝硬化腹水合并腹股沟疝患者中的应用. 中华疝和腹壁外科杂志(电子版), 2016, 10(6): 414-416.
10.	李晓斌, 吴孟闱, 刘睿, 等. Lichtenstein 手术治疗肝硬化腹水合并腹股沟疝的临床疗效. 中华消化外科杂志, 2019, 18(11): 1027-1031.
11.	王华强, 谢芳, 盛云峰, 等. 肝硬化患者发生血流感染的影响因素和病原学特点. 肝脏, 2021, 26(3): 252-254, 258.
12.	汤佳音, 罗蒙, 施志强, 等. 腹股沟疝合并肝硬化的治疗分析: 附 30 例报告. 中国普通外科杂志, 2011, 20(7): 753-755.
13.	Bruns T, Zimmermann HW, Stallmach A. Risk factors and outcome of bacterial infections in cirrhosis. World J Gastroenterol, 2014, 20(10): 2542-2554.
14.	Jalan R, Fernandez J, Wiest R, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol, 2014, 60(6): 1310-1324.
15.	任力, 郝学超, 闵苏. 日间手术的实施流程及标准. 临床麻醉学杂志, 2016, 32(10): 1023-1026.
16.	Ohuchi M, Inaki N, Nagakari K, et al. Transabdominal preperitoneal repair using barbed sutures for bilateral inguinal hernia in liver cirrhosis with ascites. J Surg Case Rep, 2019, 2019(6): rjz199.
17.	de Goede B, Klitsie PJ, Lange JF, et al. Morbidity and mortality related to non-hepatic surgery in patients with liver cirrhosis: a systematic review. Best Pract Res Clin Gastroenterol, 2012, 26(1): 47-59.
18.	夏鑫, 郭趣, 卢爽, 等. 我国日间手术研究现状与分析. 全科护理, 2023, 21(18): 2482-2485.
19.	Bunchorntavakul C, Chamroonkul N, Chavalitdhamrong D. Bacterial infections in cirrhosis: a critical review and practical guidance. World J Hepatol, 2016, 8(6): 307-321.
20.	孙丕绛, 蔡超, 于燕华, 等. 腹腔镜与开放手术治疗肝硬化合并腹股沟疝的临床对照研究. 国际医药卫生导报, 2021, 27(17): 2671-2675.
21.	罗怡君, 赵灵悦, 刘宏玥, 等. 日间手术预住院统一管理模式的建设和实践探讨. 中国卫生标准管理, 2024, 15(2): 62-65.
22.	储爱琴, 葛文杰, 张海玲, 等. “互联网+”预住院服务模式应用现状及影响因素分析. 中国医院管理, 2023, 43(5): 61-65.
23.	Inagaki M, Goto J, Okayama T, et al. “Tension-free” herniorrhaphy for groin hernias in patients with cirrhosis: report of four cases. Surg Today, 2009, 39(6): 540-543.
24.	Patti R, Almasio PL, Buscemi S, et al. Inguinal hernioplasty improves the quality of life in patients with cirrhosis. Am J Surg, 2008, 196(3): 373-378.
25.	Lee DU, Hastie DJ, Lee KJ, et al. The impact of compensated and decompensated cirrhosis on the postoperative outcomes of patients undergoing hernia repair: a propensity score-matched analysis of 2011-2017 US hospital database. Eur J Gastroenterol Hepatol, 2021, 33(Suppl 1): e944-e953.
26.	Silva FD, Andraus W, Pinheiro RS, et al. Abdominal and inguinal hernia in cirrhotic patients: what’s the best approach?. Arq Bras Cir Dig, 2012, 25(1): 52-55.
27.	Pei KY, Liu F, Zhang Y. A matched comparison of laparoscopic versus open inguinal hernia repair in patients with liver disease using propensity score matching. Hernia, 2018, 22(3): 419-426.
28.	Sidhu A, Cabalag C, Lee E, et al. Outcomes of inguinal hernia repair in cirrhotics: a single tertiary centre experience. ANZ J Surg, 2020, 90(5): 772-775.
29.	马熙, 刘晓江. 疝环充填式无张力疝修补术在肝硬化腹水患者中的应用. 临床外科杂志, 2007, 15(3): 180.
30.	罗国德, 曹永宽, 张林, 等. PHS 术式治疗腹股沟疝合并肝硬化腹水的临床观察(附 8 例报告). 安徽医学, 2012, 33(6): 697-698.
31.	魏振满, 张文瑾. 肝化腹腔感染抗生素应用的流行病学分析. 中国抗生素杂志, 1999, 24(3): 229-230.
32.	曲芬, 毛远丽, 崔恩博, 等. 肝炎及肝硬化患者葡萄球菌属的分布及耐药性. 中国抗生素杂志, 2005, 30(2): 91-93.
33.	卜昕, 曲芬, 蔡少平, 等. 肝病患者气单胞菌败血症 90 例临床特征及转归. 中国抗生素杂志, 2017, 42(7): 575-579.
34.	Lange CM, Moreau R. Immunodysfunction in acute-on-chronic liver failure. Visc Med, 2018, 34(4): 276-282.
35.	中华医学会消化病学分会. 中国肝硬化临床诊治共识意见. 临床肝胆病杂志, 2023, 39(9): 2057-2073.
36.	中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018 年版). 中华胃肠外科杂志, 2018, 21(7): 721-724.
37.	Miserez M, Peeters E, Aufenacker T, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia, 2014, 18(2): 151-163.
38.	HerniaSurge Group. International guidelines for groin hernia management. Hernia, 2018, 22(1): 1-165.
39.	Dirchwolf M, Gomez Perdiguero G, Grech IM, et al. Challenges and recommendations when selecting empirical antibiotics in patients with cirrhosis. World J Hepatol, 2023, 15(3): 377-385.
40.	Kutmutia R, Tittanegro T, China L, et al. Evaluating the role of antibiotics in patients admitted to hospital with decompensated cirrhosis: lessons from the ATTIRE trial. Am J Gastroenterol, 2023, 118(1): 105-113.
41.	Ferrarese A, Passigato N, Cusumano C, et al. Antibiotic prophylaxis in patients with cirrhosis: current evidence for clinical practice. World J Hepatol, 2021, 13(8): 840-852.

1. Li J, Qin C, Lai D, et al. Safety and effectiveness of inguinal hernia repair in patients with liver cirrhosis: a retrospective study and literature review. Hernia, 2020, 24(3): 489-494.
2. Hur YH, Kim JC, Kim DY, et al. Inguinal hernia repair in patients with liver cirrhosis accompanied by ascites. J Korean Surg Soc, 2011, 80(6): 420-425.
3. Johnson KM, Newman KL, Green PK, et al. Incidence and risk factors of postoperative mortality and morbidity after elective versus emergent abdominal surgery in a national sample of 8193 patients with cirrhosis. Ann Surg, 2021, 274(4): e345-e354.
4. Hansen JB, Thulstrup AM, Vilstup H, et al. Danish nationwide cohort study of postoperative death in patients with liver cirrhosis undergoing hernia repair. Br J Surg, 2002, 89(6): 805-806.
5. Oh HK, Kim H, Ryoo S, et al. Inguinal hernia repair in patients with cirrhosis is not associated with increased risk of complications and recurrence. World J Surg, 2011, 35(6): 1229-1233.
6. 杨世炜, 王永, 伍兵, 等. 无张力疝修补术治疗腹股沟疝合并腹腔积液的临床疗效. 中华消化外科杂志, 2017, 16(9): 911-914.
7. 李瑛, 胡振斌, 徐昆, 等. 中医药治疗肝硬化腹水临床研究概述. 中西医结合肝病杂志, 2022, 32(2): 185-188.
8. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology, 2021, 74(2): 1014-1048.
9. 张传宝, 张敬坡, 冯雷, 等. 局部神经阻滞麻醉下无张力疝修补术在肝硬化腹水合并腹股沟疝患者中的应用. 中华疝和腹壁外科杂志(电子版), 2016, 10(6): 414-416.
10. 李晓斌, 吴孟闱, 刘睿, 等. Lichtenstein 手术治疗肝硬化腹水合并腹股沟疝的临床疗效. 中华消化外科杂志, 2019, 18(11): 1027-1031.
11. 王华强, 谢芳, 盛云峰, 等. 肝硬化患者发生血流感染的影响因素和病原学特点. 肝脏, 2021, 26(3): 252-254, 258.
12. 汤佳音, 罗蒙, 施志强, 等. 腹股沟疝合并肝硬化的治疗分析: 附 30 例报告. 中国普通外科杂志, 2011, 20(7): 753-755.
13. Bruns T, Zimmermann HW, Stallmach A. Risk factors and outcome of bacterial infections in cirrhosis. World J Gastroenterol, 2014, 20(10): 2542-2554.
14. Jalan R, Fernandez J, Wiest R, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol, 2014, 60(6): 1310-1324.
15. 任力, 郝学超, 闵苏. 日间手术的实施流程及标准. 临床麻醉学杂志, 2016, 32(10): 1023-1026.
16. Ohuchi M, Inaki N, Nagakari K, et al. Transabdominal preperitoneal repair using barbed sutures for bilateral inguinal hernia in liver cirrhosis with ascites. J Surg Case Rep, 2019, 2019(6): rjz199.
17. de Goede B, Klitsie PJ, Lange JF, et al. Morbidity and mortality related to non-hepatic surgery in patients with liver cirrhosis: a systematic review. Best Pract Res Clin Gastroenterol, 2012, 26(1): 47-59.
18. 夏鑫, 郭趣, 卢爽, 等. 我国日间手术研究现状与分析. 全科护理, 2023, 21(18): 2482-2485.
19. Bunchorntavakul C, Chamroonkul N, Chavalitdhamrong D. Bacterial infections in cirrhosis: a critical review and practical guidance. World J Hepatol, 2016, 8(6): 307-321.
20. 孙丕绛, 蔡超, 于燕华, 等. 腹腔镜与开放手术治疗肝硬化合并腹股沟疝的临床对照研究. 国际医药卫生导报, 2021, 27(17): 2671-2675.
21. 罗怡君, 赵灵悦, 刘宏玥, 等. 日间手术预住院统一管理模式的建设和实践探讨. 中国卫生标准管理, 2024, 15(2): 62-65.
22. 储爱琴, 葛文杰, 张海玲, 等. “互联网+”预住院服务模式应用现状及影响因素分析. 中国医院管理, 2023, 43(5): 61-65.
23. Inagaki M, Goto J, Okayama T, et al. “Tension-free” herniorrhaphy for groin hernias in patients with cirrhosis: report of four cases. Surg Today, 2009, 39(6): 540-543.
24. Patti R, Almasio PL, Buscemi S, et al. Inguinal hernioplasty improves the quality of life in patients with cirrhosis. Am J Surg, 2008, 196(3): 373-378.
25. Lee DU, Hastie DJ, Lee KJ, et al. The impact of compensated and decompensated cirrhosis on the postoperative outcomes of patients undergoing hernia repair: a propensity score-matched analysis of 2011-2017 US hospital database. Eur J Gastroenterol Hepatol, 2021, 33(Suppl 1): e944-e953.
26. Silva FD, Andraus W, Pinheiro RS, et al. Abdominal and inguinal hernia in cirrhotic patients: what’s the best approach?. Arq Bras Cir Dig, 2012, 25(1): 52-55.
27. Pei KY, Liu F, Zhang Y. A matched comparison of laparoscopic versus open inguinal hernia repair in patients with liver disease using propensity score matching. Hernia, 2018, 22(3): 419-426.
28. Sidhu A, Cabalag C, Lee E, et al. Outcomes of inguinal hernia repair in cirrhotics: a single tertiary centre experience. ANZ J Surg, 2020, 90(5): 772-775.
29. 马熙, 刘晓江. 疝环充填式无张力疝修补术在肝硬化腹水患者中的应用. 临床外科杂志, 2007, 15(3): 180.
30. 罗国德, 曹永宽, 张林, 等. PHS 术式治疗腹股沟疝合并肝硬化腹水的临床观察(附 8 例报告). 安徽医学, 2012, 33(6): 697-698.
31. 魏振满, 张文瑾. 肝化腹腔感染抗生素应用的流行病学分析. 中国抗生素杂志, 1999, 24(3): 229-230.
32. 曲芬, 毛远丽, 崔恩博, 等. 肝炎及肝硬化患者葡萄球菌属的分布及耐药性. 中国抗生素杂志, 2005, 30(2): 91-93.
33. 卜昕, 曲芬, 蔡少平, 等. 肝病患者气单胞菌败血症 90 例临床特征及转归. 中国抗生素杂志, 2017, 42(7): 575-579.
34. Lange CM, Moreau R. Immunodysfunction in acute-on-chronic liver failure. Visc Med, 2018, 34(4): 276-282.
35. 中华医学会消化病学分会. 中国肝硬化临床诊治共识意见. 临床肝胆病杂志, 2023, 39(9): 2057-2073.
36. 中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018 年版). 中华胃肠外科杂志, 2018, 21(7): 721-724.
37. Miserez M, Peeters E, Aufenacker T, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia, 2014, 18(2): 151-163.
38. HerniaSurge Group. International guidelines for groin hernia management. Hernia, 2018, 22(1): 1-165.
39. Dirchwolf M, Gomez Perdiguero G, Grech IM, et al. Challenges and recommendations when selecting empirical antibiotics in patients with cirrhosis. World J Hepatol, 2023, 15(3): 377-385.
40. Kutmutia R, Tittanegro T, China L, et al. Evaluating the role of antibiotics in patients admitted to hospital with decompensated cirrhosis: lessons from the ATTIRE trial. Am J Gastroenterol, 2023, 118(1): 105-113.
41. Ferrarese A, Passigato N, Cusumano C, et al. Antibiotic prophylaxis in patients with cirrhosis: current evidence for clinical practice. World J Hepatol, 2021, 13(8): 840-852.

West China Medical Journal

Feasibility exploration of day surgery for inguinal hernia combined with cirrhotic ascites

Abstract Full text Figures/Tables Video References Cited by

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