Przepuklina pępkowa
Rokowania, prognozy i postęp choroby

Rokowanie w leczeniu przepukliny pępkowej jest generalnie korzystne, jednak zależy od wielu czynników, takich jak wielkość ubytku powięziowego, obecność chorób współistniejących (np. marskość wątroby, cukrzyca), status ASA ≥3 oraz technika operacyjna, w tym zastosowanie siatki przy ubytkach ≥2 cm. Każdy 1 mm wzrostu rozmiaru ubytku zwiększa ryzyko powikłań chirurgicznych o 1%, a u pacjentów z marskością wątroby każdy punkt wzrostu wyniku MELD powyżej 8,5 wiąże się ze wzrostem powikłań o 13,8%. Nawrót przepukliny występuje u 1-3% pacjentów po naprawie z użyciem siatki, a w przypadku laparoskopowej naprawy przepuklin pooperacyjnych wskaźnik nawrotów wynosi 6,7% w porównaniu do 0,9% dla przepuklin pierwotnych (p<0,001). Zastosowanie wchłanialnych zszywek i konieczność reinterwencji zwiększają ryzyko nawrotu odpowiednio 2,94- i 2,89-krotnie.

  1. Rokowanie przepukliny pępkowej
    1. Wskaźniki idealnych wyników leczenia
    2. Czynniki wpływające na wyniki leczenia
    3. Wskaźniki nawrotów
  2. Szczególne grupy pacjentów z przepukliną pępkową
    1. Pacjenci z marskością wątroby
    2. Przepukliny pępkowe u cieląt – analogia kliniczna
  3. Wnioski prognostyczne
    1. Kolejne rozdziały

Rokowanie przepukliny pępkowej

Przewidywanie wyników leczenia przepukliny pępkowej jest złożonym procesem, zależnym od wielu czynników, zarówno związanych z pacjentem, jak i techniką operacyjną. Rokowanie w przypadku przepukliny pępkowej jest generalnie dobre, choć istnieją znaczące różnice między populacją pediatryczną a dorosłymi.1 U dzieci przepukliny pępkowe zwykle goją się samoistnie z czasem, podczas gdy u dorosłych są uznawane za stan wyższego ryzyka, wymagający interwencji chirurgicznej.2

Wskaźniki idealnych wyników leczenia

Idealny wynik leczenia przepukliny pępkowej definiuje się jako stan, w którym pacjent pozostaje bezobjawowy i nie występuje nawrót przepukliny. Badania wskazują jednak, że w przypadku dużych przepuklin pępkowych (o wielkości ubytku ≥9 cm²) odsetek idealnych wyników jest zaskakująco niski. Warto zauważyć, że wszyscy pacjenci z nieidealnym długoterminowym wynikiem leczenia cierpieli na ból przedoperacyjny i mieli ograniczenia aktywności. Dane te sugerują, że przepukliny pępkowe powinny być naprawiane, gdy są małe i bezobjawowe.3

Czynniki wpływające na wyniki leczenia

Wyniki leczenia przepukliny pępkowej są determinowane przez kilka kluczowych czynników, w tym:

  • Wielkość ubytku – każdy 1 mm wzrostu rozmiaru powięziowego ubytku zwiększa wskaźnik powikłań chirurgicznych o 1%4
  • Aktualne używanie tytoniu – historia używania tytoniu negatywnie wpływa na sukces naprawy5
  • Choroby współistniejące – w szczególności niewydolność wątroby i cukrzyca mają znaczący wpływ na wyniki6
  • Wynik ASA ≥3 (American Society of Anesthesiologists) – wskazuje na zwiększone ryzyko powikłań7
  • Brak zastosowania siatki dla przepuklin o średnicy ≥2 cm – wpływa negatywnie na trwałość naprawy8

Wskaźniki nawrotów

Większość pacjentów poddanych naprawie przepukliny pępkowej ma dobre wyniki, jednak nawrót może wystąpić w około 1-3% przypadków, nawet gdy zastosowano siatkę.9 Badania dotyczące laparoskopowej naprawy przepukliny brzusznej (LVHR) wykazały ogólny wskaźnik nawrotów na poziomie 4,7% przy średnim okresie obserwacji wynoszącym 30,4 miesiąca.10

Interesujące jest, że przepukliny pooperacyjne (incyzyjne) mają wyższy wskaźnik nawrotów niż przepukliny pierwotne (6,7% vs 0,9%, p<0,001), przy czym prawie wszystkie przypadki nawrotów odnotowano wśród pacjentów z przepuklinami pooperacyjnymi.11 Analiza wieloczynnikowa wykazała, że zastosowanie wchłanialnych zszywek i ponowna interwencja są głównymi czynnikami ryzyka, zwiększając ryzyko nawrotu odpowiednio 2,94 i 2,89 razy.12

Szczególne grupy pacjentów z przepukliną pępkową

Pacjenci z marskością wątroby

Pacjenci z marskością wątroby stanowią szczególną grupę ryzyka w kontekście przepuklin pępkowych. Częstość występowania przepuklin ściany brzucha u pacjentów z marskością wątroby wynosi 20-40%.13 W tej grupie pacjentów objawowe przepukliny pępkowe mogą wystąpić nawet u 20% osób z krańcową niewydolnością wątroby.14

Ocena rokowania u pacjentów z marskością wątroby wymaga uwzględnienia skali MELD (Model for End-Stage Liver Disease). Wskaźnik powikłań pooperacyjnych wzrasta o 13,8% na każdy 1-punktowy wzrost wyniku MELD powyżej standardowego średniego poziomu 8,5.15 Dane sugerują, że następujące czynniki są związane z gorszym rokowaniem u pacjentów z marskością:

W przeciwieństwie do tego, operacja planowa wydaje się być bardziej skuteczna i związana z niższym wskaźnikiem śmiertelności.21 Prawidłowy czas operacji to zabieg planowy po wodobrzusza/” title=”drenaż wodobrzusza” class=”to-tag” data-termid=”128795″>drenażu wodobrzusza oraz korekcji poziomu albuminy/elektrolitów w surowicy i zaburzeń krzepnięcia.22

W specjalistycznym ośrodku transplantacji wątroby śmiertelność po 30 dniach i 365 dniach wynosi odpowiednio 4,5% i 9,9%. Czynnikami predykcyjnymi śmiertelności w ciągu 365 dni od operacji są wiek ≥60 lat (HR 4,5, p=0,026) i przyjęcie na oddział intensywnej terapii (HR 10,5, p=0,001).23

Przepukliny pępkowe u cieląt – analogia kliniczna

Chociaż nie jest to bezpośrednio związane z ludzkimi pacjentami, badania weterynaryjne dotyczące przepuklin pępkowych u cieląt mogą dostarczyć interesujących analogii klinicznych. Leczenie chirurgiczne uwięźniętych przepuklin pępkowych u cieląt generalnie daje pozytywne rokowanie, szczególnie przy braku zadzierzgnięcia przewodu pokarmowego.24

Wskaźniki przeżycia w tej grupie są imponujące:

  • 84% ogólny wskaźnik przeżycia krótkoterminowego25
  • 93% wskaźnik przeżycia długoterminowego wśród zwierząt, dla których dostępne były informacje z okresu obserwacji26
  • Cielęta ze zdiagnozowanymi zadzierzgniętymi uwięźniętymi przepuklinami pępkowymi miały wskaźnik przeżycia krótkoterminowego na poziomie 66%, w porównaniu do 100% u tych bez zadzierzgnięcia przewodu pokarmowego27

Wnioski prognostyczne

Ogólne rokowanie w przypadku przepukliny pępkowej jest dobre, szczególnie gdy zabieg chirurgiczny przeprowadzany jest w warunkach planowych i u pacjentów bez poważnych chorób współistniejących.2829 Kilka kluczowych wniosków prognostycznych obejmuje:

  • U dzieci przepukliny pępkowe często goją się samoistnie30
  • Leczenie chirurgiczne przepuklin pępkowych jest bardzo skuteczne, a ryzyko nawrotu przepukliny jest niskie31
  • Operacja planowa ma przewagę nad operacją w trybie pilnym, szczególnie u pacjentów z marskością wątroby32
  • Zastosowanie niewchłanialnych lub mieszanych systemów mocowania siatki może zmniejszyć ryzyko nawrotu, szczególnie w przypadku przepuklin pooperacyjnych33
  • Wczesna interwencja, gdy przepukliny są małe i bezobjawowe, może prowadzić do lepszych wyników długoterminowych34

Multidyscyplinarne podejście do leczenia pacjentów z przepukliną pępkową, szczególnie tych z chorobami współistniejącymi, może znacząco poprawić wyniki leczenia.35 Ponadto, techniki laparoskopowe z zastosowaniem lekkiej siatki polipropylenowej wykazują niskie wskaźniki powikłań śródoperacyjnych i akceptowalne wskaźniki powikłań pooperacyjnych i późnych zarówno w przypadku przepuklin pierwotnych, jak i pooperacyjnych.36

Czynnik prognostyczny Wpływ na rokowanie Wskaźnik ryzyka
Wielkość ubytku Każdy 1 mm wzrostu rozmiaru ubytku Wzrost powikłań o 1%
Wynik MELD u pacjentów z marskością Każdy 1-punktowy wzrost powyżej 8,5 Wzrost powikłań o 13,8%
Zastosowanie wchłanialnych zszywek Zwiększone ryzyko nawrotu HR 2,94 (95% CI 1,18-7,31)
Reinterwencja chirurgiczna Zwiększone ryzyko nawrotu HR 2,89
Wiek ≥60 lat u pacjentów z marskością Zwiększone ryzyko śmiertelności w ciągu roku HR 4,5 (p=0,026)
Przyjęcie na OIT u pacjentów z marskością Zwiększone ryzyko śmiertelności w ciągu roku HR 10,5 (p=0,001)
Typ przepukliny Pooperacyjna vs. pierwotna Wyższy wskaźnik nawrotów (6,7% vs 0,9%)

Kolejne rozdziały

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Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Umbilical Hernia: Symptoms, What It Is, Treatment & Surgery
    https://my.clevelandclinic.org/health/diseases/umbilical-hernia
    Umbilical hernias usually have a positive outcome. Most childhood hernias heal naturally over time. Surgery to treat umbilical hernias is also very effective, and the risk of the hernia coming back is low. […] Its possible for an umbilical hernia to return after surgery, but its uncommon. Ask your healthcare provider what you can do to reduce your risk of a hernia coming back. […] An umbilical hernias seriousness has everything to do with who has it. In children, umbilical hernias are common and usually dont cause problems. In adults, theyre considered more high risk. Even if a hernia isnt causing problems now, it can potentially cause issues in the future. If your providers concerned about complications, hernia repair surgery can help.
  • #2 Umbilical Hernia: Symptoms, What It Is, Treatment & Surgery
    https://my.clevelandclinic.org/health/diseases/umbilical-hernia
    Umbilical hernias usually have a positive outcome. Most childhood hernias heal naturally over time. Surgery to treat umbilical hernias is also very effective, and the risk of the hernia coming back is low. […] Its possible for an umbilical hernia to return after surgery, but its uncommon. Ask your healthcare provider what you can do to reduce your risk of a hernia coming back. […] An umbilical hernias seriousness has everything to do with who has it. In children, umbilical hernias are common and usually dont cause problems. In adults, theyre considered more high risk. Even if a hernia isnt causing problems now, it can potentially cause issues in the future. If your providers concerned about complications, hernia repair surgery can help.
  • #3 Identifying Effectors of Outcomes in Patients with Large Umbilical Hernias – PubMed
    https://pubmed.ncbi.nlm.nih.gov/27457860/
    Quality of life (QOL) has become an important focus of hernia repair outcomes. This study aims to identify factors which lead to ideal outcomes (asymptomatic and without recurrence) in large umbilical hernias (defect size 9 cm(2)). […] Repair of umbilical hernia with defects 9 cm(2) had a surprising low rate of ideal outcomes (asymptomatic and no recurrence). All patients with nonideal long-term outcomes had preoperative pain and activity limitations. These data may suggest that umbilical hernia should be repaired when they are small and asymptomatic.
  • #4 Umbilical Hernia – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK459312/
    Factors influencing the outcome of an umbilical hernia repair include the defect size, current tobacco use, and comorbidities. An American Society of Anesthesiologists (ASA) score 3, failure to use mesh for hernias measuring 2 cm, tobacco use history, liver failure, and diabetes impact the success of the repair. The surgical complication rate increases by 1% for each 1 mm in fascial defect size. The Model for End-State Liver Disease (MELD) score has been used to estimate the increased risk in liver failure patients. The postoperative complication rate increases by 13.8% for every 1-point increase in the MELD score above the standard mean level of 8.5. […] Most patients who undergo umbilical hernia repair have good outcomes, but recurrence may occur in up to about 1% to 3% of cases, even when a mesh is used.
  • #5 Umbilical Hernia – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK459312/
    Factors influencing the outcome of an umbilical hernia repair include the defect size, current tobacco use, and comorbidities. An American Society of Anesthesiologists (ASA) score 3, failure to use mesh for hernias measuring 2 cm, tobacco use history, liver failure, and diabetes impact the success of the repair. The surgical complication rate increases by 1% for each 1 mm in fascial defect size. The Model for End-State Liver Disease (MELD) score has been used to estimate the increased risk in liver failure patients. The postoperative complication rate increases by 13.8% for every 1-point increase in the MELD score above the standard mean level of 8.5. […] Most patients who undergo umbilical hernia repair have good outcomes, but recurrence may occur in up to about 1% to 3% of cases, even when a mesh is used.
  • #6 Umbilical Hernia – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK459312/
    Factors influencing the outcome of an umbilical hernia repair include the defect size, current tobacco use, and comorbidities. An American Society of Anesthesiologists (ASA) score 3, failure to use mesh for hernias measuring 2 cm, tobacco use history, liver failure, and diabetes impact the success of the repair. The surgical complication rate increases by 1% for each 1 mm in fascial defect size. The Model for End-State Liver Disease (MELD) score has been used to estimate the increased risk in liver failure patients. The postoperative complication rate increases by 13.8% for every 1-point increase in the MELD score above the standard mean level of 8.5. […] Most patients who undergo umbilical hernia repair have good outcomes, but recurrence may occur in up to about 1% to 3% of cases, even when a mesh is used.
  • #7 Umbilical Hernia – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK459312/
    Factors influencing the outcome of an umbilical hernia repair include the defect size, current tobacco use, and comorbidities. An American Society of Anesthesiologists (ASA) score 3, failure to use mesh for hernias measuring 2 cm, tobacco use history, liver failure, and diabetes impact the success of the repair. The surgical complication rate increases by 1% for each 1 mm in fascial defect size. The Model for End-State Liver Disease (MELD) score has been used to estimate the increased risk in liver failure patients. The postoperative complication rate increases by 13.8% for every 1-point increase in the MELD score above the standard mean level of 8.5. […] Most patients who undergo umbilical hernia repair have good outcomes, but recurrence may occur in up to about 1% to 3% of cases, even when a mesh is used.
  • #8 Umbilical Hernia – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK459312/
    Factors influencing the outcome of an umbilical hernia repair include the defect size, current tobacco use, and comorbidities. An American Society of Anesthesiologists (ASA) score 3, failure to use mesh for hernias measuring 2 cm, tobacco use history, liver failure, and diabetes impact the success of the repair. The surgical complication rate increases by 1% for each 1 mm in fascial defect size. The Model for End-State Liver Disease (MELD) score has been used to estimate the increased risk in liver failure patients. The postoperative complication rate increases by 13.8% for every 1-point increase in the MELD score above the standard mean level of 8.5. […] Most patients who undergo umbilical hernia repair have good outcomes, but recurrence may occur in up to about 1% to 3% of cases, even when a mesh is used.
  • #9 Umbilical Hernia – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK459312/
    Factors influencing the outcome of an umbilical hernia repair include the defect size, current tobacco use, and comorbidities. An American Society of Anesthesiologists (ASA) score 3, failure to use mesh for hernias measuring 2 cm, tobacco use history, liver failure, and diabetes impact the success of the repair. The surgical complication rate increases by 1% for each 1 mm in fascial defect size. The Model for End-State Liver Disease (MELD) score has been used to estimate the increased risk in liver failure patients. The postoperative complication rate increases by 13.8% for every 1-point increase in the MELD score above the standard mean level of 8.5. […] Most patients who undergo umbilical hernia repair have good outcomes, but recurrence may occur in up to about 1% to 3% of cases, even when a mesh is used.
  • #10 Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study | Scientific Reports
    https://www.nature.com/articles/s41598-022-08024-3
    Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. Prevention of recurrence is crucial and still highly debated. […] IH group presented at major risk of recurrence than PH (6.7% vs 0.9%, p0.001) and application of absorbable tacks resulted a significative predictive factor for recurrence increasing the risk by 2.94 (95% CI 1.187.31). […] The overall recurrence rate for the total cohort of patients was 4.7% (n=47) at a mean follow-up of 30.4 months. […] IH group presented a higher rate of recurrence than PH (6.7% vs 0.9%, p0.001), with almost all cases registered among IH patients (n=44). […] Interestingly, at univariable analysis on 665 IH cases BMI, hernia size and location were not found to be predictive factors of recurrence, as well being primary incisional or recurrent incisional hernia.
  • #11 Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study | Scientific Reports
    https://www.nature.com/articles/s41598-022-08024-3
    Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. Prevention of recurrence is crucial and still highly debated. […] IH group presented at major risk of recurrence than PH (6.7% vs 0.9%, p0.001) and application of absorbable tacks resulted a significative predictive factor for recurrence increasing the risk by 2.94 (95% CI 1.187.31). […] The overall recurrence rate for the total cohort of patients was 4.7% (n=47) at a mean follow-up of 30.4 months. […] IH group presented a higher rate of recurrence than PH (6.7% vs 0.9%, p0.001), with almost all cases registered among IH patients (n=44). […] Interestingly, at univariable analysis on 665 IH cases BMI, hernia size and location were not found to be predictive factors of recurrence, as well being primary incisional or recurrent incisional hernia.
  • #12 Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study | Scientific Reports
    https://www.nature.com/articles/s41598-022-08024-3
    Multivariate analysis identified the application of absorbable tacks and reintervention as major risk factors, increasing risk of recurrence by 2.94 and 2.89 times, respectively. […] The current study suggests that LVHR procedure with a light-weight polypropylene mesh has low intra-operative complication rates and acceptable post-operative and late complication rates for both IH and PH. IH patients are at a much higher risk of recurrence and surgical strategy should prefer non absorbable or mixed fixation systems. The current authors suggest that absorbable tacks alone should be avoided in LVHR interventions.
  • #13 The abdominal wall hernia in cirrhotic patients: a historical challenge | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0196-z
    The incidence rate of abdominal wall hernia is 2040% in cirrhotic patients. […] Several studies have demonstrated that elective surgery in cirrhotic patients could be safe, even when refractory ascites or advanced cirrhosis is diagnosed, if it is performed in a high-volume liver center. […] The worst outcome is associated with emergency surgery and with uncontrolled disease. […] The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction. […] The data proposed suggest that emergency, CPT-C, ASA score 3, and MELD score 20 are risk factors for postoperative morbidity and mortality. […] In contrast, elective surgery appears to be successful and to be associated with lower mortality rate.
  • #14 PWE-39 A multidisciplinary approach to symptomatic umbilical hernia in patients with ESLD optimises outcome | Gut
    https://gut.bmj.com/content/70/Suppl_4/A124
    Symptomatic umbilical hernias can occur in up to 20% of patients with cirrhosis and end-stage liver disease. […] We aimed to determine the outcome and the factors predicting mortality following repair of symptomatic umbilical hernias in this group of patients. […] Mortality at 30d and 365d was 4.5% and 9.9%, respectively. […] Age60 (HR 4.5 p=0.026) and ITU admission (HR 10.5 p=0.001) predicted mortality within 365 days of surgery. […] Symptomatic umbilical hernias in patients with cirrhosis can be treated safely with acceptable outcomes in a specialist liver transplant centre, however this remains a high risk intervention. […] We attribute our outcomes to a multidisciplinary approach to management of patients with ESLD and an umbilical hernia. TIPS may improve short-term outcomes but further prospective trials are warranted.
  • #15 Umbilical Hernia – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK459312/
    Factors influencing the outcome of an umbilical hernia repair include the defect size, current tobacco use, and comorbidities. An American Society of Anesthesiologists (ASA) score 3, failure to use mesh for hernias measuring 2 cm, tobacco use history, liver failure, and diabetes impact the success of the repair. The surgical complication rate increases by 1% for each 1 mm in fascial defect size. The Model for End-State Liver Disease (MELD) score has been used to estimate the increased risk in liver failure patients. The postoperative complication rate increases by 13.8% for every 1-point increase in the MELD score above the standard mean level of 8.5. […] Most patients who undergo umbilical hernia repair have good outcomes, but recurrence may occur in up to about 1% to 3% of cases, even when a mesh is used.
  • #16 The abdominal wall hernia in cirrhotic patients: a historical challenge | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0196-z
    The incidence rate of abdominal wall hernia is 2040% in cirrhotic patients. […] Several studies have demonstrated that elective surgery in cirrhotic patients could be safe, even when refractory ascites or advanced cirrhosis is diagnosed, if it is performed in a high-volume liver center. […] The worst outcome is associated with emergency surgery and with uncontrolled disease. […] The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction. […] The data proposed suggest that emergency, CPT-C, ASA score 3, and MELD score 20 are risk factors for postoperative morbidity and mortality. […] In contrast, elective surgery appears to be successful and to be associated with lower mortality rate.
  • #17 The abdominal wall hernia in cirrhotic patients: a historical challenge | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0196-z
    According to the multivariate analysis, elective surgery is preferable concerning the timing for hernia repair. Emergency surgery is strongly associated with a higher incidence of postoperative morbidity and mortality. […] The results of the data analysis show that performing the surgical operation of abdominal wall hernia repair in cirrhotic patients emergently is related to higher postoperative morbidity and mortality rates.
  • #18 The abdominal wall hernia in cirrhotic patients: a historical challenge | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0196-z
    The incidence rate of abdominal wall hernia is 2040% in cirrhotic patients. […] Several studies have demonstrated that elective surgery in cirrhotic patients could be safe, even when refractory ascites or advanced cirrhosis is diagnosed, if it is performed in a high-volume liver center. […] The worst outcome is associated with emergency surgery and with uncontrolled disease. […] The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction. […] The data proposed suggest that emergency, CPT-C, ASA score 3, and MELD score 20 are risk factors for postoperative morbidity and mortality. […] In contrast, elective surgery appears to be successful and to be associated with lower mortality rate.
  • #19 The abdominal wall hernia in cirrhotic patients: a historical challenge | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0196-z
    The incidence rate of abdominal wall hernia is 2040% in cirrhotic patients. […] Several studies have demonstrated that elective surgery in cirrhotic patients could be safe, even when refractory ascites or advanced cirrhosis is diagnosed, if it is performed in a high-volume liver center. […] The worst outcome is associated with emergency surgery and with uncontrolled disease. […] The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction. […] The data proposed suggest that emergency, CPT-C, ASA score 3, and MELD score 20 are risk factors for postoperative morbidity and mortality. […] In contrast, elective surgery appears to be successful and to be associated with lower mortality rate.
  • #20 The abdominal wall hernia in cirrhotic patients: a historical challenge | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0196-z
    The incidence rate of abdominal wall hernia is 2040% in cirrhotic patients. […] Several studies have demonstrated that elective surgery in cirrhotic patients could be safe, even when refractory ascites or advanced cirrhosis is diagnosed, if it is performed in a high-volume liver center. […] The worst outcome is associated with emergency surgery and with uncontrolled disease. […] The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction. […] The data proposed suggest that emergency, CPT-C, ASA score 3, and MELD score 20 are risk factors for postoperative morbidity and mortality. […] In contrast, elective surgery appears to be successful and to be associated with lower mortality rate.
  • #21 The abdominal wall hernia in cirrhotic patients: a historical challenge | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0196-z
    The incidence rate of abdominal wall hernia is 2040% in cirrhotic patients. […] Several studies have demonstrated that elective surgery in cirrhotic patients could be safe, even when refractory ascites or advanced cirrhosis is diagnosed, if it is performed in a high-volume liver center. […] The worst outcome is associated with emergency surgery and with uncontrolled disease. […] The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction. […] The data proposed suggest that emergency, CPT-C, ASA score 3, and MELD score 20 are risk factors for postoperative morbidity and mortality. […] In contrast, elective surgery appears to be successful and to be associated with lower mortality rate.
  • #22 The abdominal wall hernia in cirrhotic patients: a historical challenge | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0196-z
    The incidence rate of abdominal wall hernia is 2040% in cirrhotic patients. […] Several studies have demonstrated that elective surgery in cirrhotic patients could be safe, even when refractory ascites or advanced cirrhosis is diagnosed, if it is performed in a high-volume liver center. […] The worst outcome is associated with emergency surgery and with uncontrolled disease. […] The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction. […] The data proposed suggest that emergency, CPT-C, ASA score 3, and MELD score 20 are risk factors for postoperative morbidity and mortality. […] In contrast, elective surgery appears to be successful and to be associated with lower mortality rate.
  • #23 PWE-39 A multidisciplinary approach to symptomatic umbilical hernia in patients with ESLD optimises outcome | Gut
    https://gut.bmj.com/content/70/Suppl_4/A124
    Symptomatic umbilical hernias can occur in up to 20% of patients with cirrhosis and end-stage liver disease. […] We aimed to determine the outcome and the factors predicting mortality following repair of symptomatic umbilical hernias in this group of patients. […] Mortality at 30d and 365d was 4.5% and 9.9%, respectively. […] Age60 (HR 4.5 p=0.026) and ITU admission (HR 10.5 p=0.001) predicted mortality within 365 days of surgery. […] Symptomatic umbilical hernias in patients with cirrhosis can be treated safely with acceptable outcomes in a specialist liver transplant centre, however this remains a high risk intervention. […] We attribute our outcomes to a multidisciplinary approach to management of patients with ESLD and an umbilical hernia. TIPS may improve short-term outcomes but further prospective trials are warranted.
  • #24 Surgically managed incarcerated umbilical hernias in calves hold favorable prognosis: a retrospective analysis of 19 cases (2004–2021) in: Journal of the American Veterinary Medical Association Volume 262 Issue 12 (2024)
    https://avmajournals.avma.org/view/journals/javma/262/12/javma.24.06.0384.xml
    Surgically managed incarcerated umbilical hernias in calves hold favorable prognosis: a retrospective analysis of 19 cases (20042021) […] This study demonstrated that herniorrhaphy for incarcerated umbilical hernias in calves is associated with a favorable prognosis. […] Surgical intervention for incarcerated umbilical hernias in calves generally yields a positive prognosis, particularly in the absence of gastrointestinal tract strangulation, highlighting the importance of timely diagnosis and treatment. […] Eighteen calves survived the surgery, with 16 of them surviving to hospital discharge (84% overall short-term survival rate). […] For long-term survival, data were available for 15 of the 16 discharged calves, and 14 of them survived for at least 1 year after surgery, giving a long-term survival rate of 93% among the animals for which follow-up information was available.
  • #25 Surgically managed incarcerated umbilical hernias in calves hold favorable prognosis: a retrospective analysis of 19 cases (2004–2021) in: Journal of the American Veterinary Medical Association Volume 262 Issue 12 (2024)
    https://avmajournals.avma.org/view/journals/javma/262/12/javma.24.06.0384.xml
    Surgically managed incarcerated umbilical hernias in calves hold favorable prognosis: a retrospective analysis of 19 cases (20042021) […] This study demonstrated that herniorrhaphy for incarcerated umbilical hernias in calves is associated with a favorable prognosis. […] Surgical intervention for incarcerated umbilical hernias in calves generally yields a positive prognosis, particularly in the absence of gastrointestinal tract strangulation, highlighting the importance of timely diagnosis and treatment. […] Eighteen calves survived the surgery, with 16 of them surviving to hospital discharge (84% overall short-term survival rate). […] For long-term survival, data were available for 15 of the 16 discharged calves, and 14 of them survived for at least 1 year after surgery, giving a long-term survival rate of 93% among the animals for which follow-up information was available.
  • #26 Surgically managed incarcerated umbilical hernias in calves hold favorable prognosis: a retrospective analysis of 19 cases (2004–2021) in: Journal of the American Veterinary Medical Association Volume 262 Issue 12 (2024)
    https://avmajournals.avma.org/view/journals/javma/262/12/javma.24.06.0384.xml
    Surgically managed incarcerated umbilical hernias in calves hold favorable prognosis: a retrospective analysis of 19 cases (20042021) […] This study demonstrated that herniorrhaphy for incarcerated umbilical hernias in calves is associated with a favorable prognosis. […] Surgical intervention for incarcerated umbilical hernias in calves generally yields a positive prognosis, particularly in the absence of gastrointestinal tract strangulation, highlighting the importance of timely diagnosis and treatment. […] Eighteen calves survived the surgery, with 16 of them surviving to hospital discharge (84% overall short-term survival rate). […] For long-term survival, data were available for 15 of the 16 discharged calves, and 14 of them survived for at least 1 year after surgery, giving a long-term survival rate of 93% among the animals for which follow-up information was available.
  • #27 Surgically managed incarcerated umbilical hernias in calves hold favorable prognosis: a retrospective analysis of 19 cases (2004–2021) in: Journal of the American Veterinary Medical Association Volume 262 Issue 12 (2024)
    https://avmajournals.avma.org/view/journals/javma/262/12/javma.24.06.0384.xml
    Calves diagnosed with strangulated incarcerated umbilical hernias had a short-term survival rate of 66% (6 of 9), compared to 100% (10 of 10) of those without gastrointestinal tract strangulation. […] However, there was ultimately no difference in survival rates between calves with or without strangulated gastrointestinal tract. […] The overall median survival time of the calves of this study (1,995 days) is comparable to that reported by Williams et al for surgical treatment of various umbilical diseases. […] In conclusion, surgical treatment has a favorable prognosis, with good long-term survival results overall.
  • #28 Umbilical Hernia: Symptoms, What It Is, Treatment & Surgery
    https://my.clevelandclinic.org/health/diseases/umbilical-hernia
    Umbilical hernias usually have a positive outcome. Most childhood hernias heal naturally over time. Surgery to treat umbilical hernias is also very effective, and the risk of the hernia coming back is low. […] Its possible for an umbilical hernia to return after surgery, but its uncommon. Ask your healthcare provider what you can do to reduce your risk of a hernia coming back. […] An umbilical hernias seriousness has everything to do with who has it. In children, umbilical hernias are common and usually dont cause problems. In adults, theyre considered more high risk. Even if a hernia isnt causing problems now, it can potentially cause issues in the future. If your providers concerned about complications, hernia repair surgery can help.
  • #29 The abdominal wall hernia in cirrhotic patients: a historical challenge | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0196-z
    The incidence rate of abdominal wall hernia is 2040% in cirrhotic patients. […] Several studies have demonstrated that elective surgery in cirrhotic patients could be safe, even when refractory ascites or advanced cirrhosis is diagnosed, if it is performed in a high-volume liver center. […] The worst outcome is associated with emergency surgery and with uncontrolled disease. […] The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction. […] The data proposed suggest that emergency, CPT-C, ASA score 3, and MELD score 20 are risk factors for postoperative morbidity and mortality. […] In contrast, elective surgery appears to be successful and to be associated with lower mortality rate.
  • #30 Umbilical Hernia: Symptoms, What It Is, Treatment & Surgery
    https://my.clevelandclinic.org/health/diseases/umbilical-hernia
    Umbilical hernias usually have a positive outcome. Most childhood hernias heal naturally over time. Surgery to treat umbilical hernias is also very effective, and the risk of the hernia coming back is low. […] Its possible for an umbilical hernia to return after surgery, but its uncommon. Ask your healthcare provider what you can do to reduce your risk of a hernia coming back. […] An umbilical hernias seriousness has everything to do with who has it. In children, umbilical hernias are common and usually dont cause problems. In adults, theyre considered more high risk. Even if a hernia isnt causing problems now, it can potentially cause issues in the future. If your providers concerned about complications, hernia repair surgery can help.
  • #31 Umbilical Hernia: Symptoms, What It Is, Treatment & Surgery
    https://my.clevelandclinic.org/health/diseases/umbilical-hernia
    Umbilical hernias usually have a positive outcome. Most childhood hernias heal naturally over time. Surgery to treat umbilical hernias is also very effective, and the risk of the hernia coming back is low. […] Its possible for an umbilical hernia to return after surgery, but its uncommon. Ask your healthcare provider what you can do to reduce your risk of a hernia coming back. […] An umbilical hernias seriousness has everything to do with who has it. In children, umbilical hernias are common and usually dont cause problems. In adults, theyre considered more high risk. Even if a hernia isnt causing problems now, it can potentially cause issues in the future. If your providers concerned about complications, hernia repair surgery can help.
  • #32 The abdominal wall hernia in cirrhotic patients: a historical challenge | World Journal of Emergency Surgery | Full Text
    https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0196-z
    According to the multivariate analysis, elective surgery is preferable concerning the timing for hernia repair. Emergency surgery is strongly associated with a higher incidence of postoperative morbidity and mortality. […] The results of the data analysis show that performing the surgical operation of abdominal wall hernia repair in cirrhotic patients emergently is related to higher postoperative morbidity and mortality rates.
  • #33 Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study | Scientific Reports
    https://www.nature.com/articles/s41598-022-08024-3
    Multivariate analysis identified the application of absorbable tacks and reintervention as major risk factors, increasing risk of recurrence by 2.94 and 2.89 times, respectively. […] The current study suggests that LVHR procedure with a light-weight polypropylene mesh has low intra-operative complication rates and acceptable post-operative and late complication rates for both IH and PH. IH patients are at a much higher risk of recurrence and surgical strategy should prefer non absorbable or mixed fixation systems. The current authors suggest that absorbable tacks alone should be avoided in LVHR interventions.
  • #34 Identifying Effectors of Outcomes in Patients with Large Umbilical Hernias – PubMed
    https://pubmed.ncbi.nlm.nih.gov/27457860/
    Quality of life (QOL) has become an important focus of hernia repair outcomes. This study aims to identify factors which lead to ideal outcomes (asymptomatic and without recurrence) in large umbilical hernias (defect size 9 cm(2)). […] Repair of umbilical hernia with defects 9 cm(2) had a surprising low rate of ideal outcomes (asymptomatic and no recurrence). All patients with nonideal long-term outcomes had preoperative pain and activity limitations. These data may suggest that umbilical hernia should be repaired when they are small and asymptomatic.
  • #35 PWE-39 A multidisciplinary approach to symptomatic umbilical hernia in patients with ESLD optimises outcome | Gut
    https://gut.bmj.com/content/70/Suppl_4/A124
    Symptomatic umbilical hernias can occur in up to 20% of patients with cirrhosis and end-stage liver disease. […] We aimed to determine the outcome and the factors predicting mortality following repair of symptomatic umbilical hernias in this group of patients. […] Mortality at 30d and 365d was 4.5% and 9.9%, respectively. […] Age60 (HR 4.5 p=0.026) and ITU admission (HR 10.5 p=0.001) predicted mortality within 365 days of surgery. […] Symptomatic umbilical hernias in patients with cirrhosis can be treated safely with acceptable outcomes in a specialist liver transplant centre, however this remains a high risk intervention. […] We attribute our outcomes to a multidisciplinary approach to management of patients with ESLD and an umbilical hernia. TIPS may improve short-term outcomes but further prospective trials are warranted.
  • #36 Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study | Scientific Reports
    https://www.nature.com/articles/s41598-022-08024-3
    Multivariate analysis identified the application of absorbable tacks and reintervention as major risk factors, increasing risk of recurrence by 2.94 and 2.89 times, respectively. […] The current study suggests that LVHR procedure with a light-weight polypropylene mesh has low intra-operative complication rates and acceptable post-operative and late complication rates for both IH and PH. IH patients are at a much higher risk of recurrence and surgical strategy should prefer non absorbable or mixed fixation systems. The current authors suggest that absorbable tacks alone should be avoided in LVHR interventions.

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naprawa przepukliny pępkowej zaburzenia krzepnięcia duża przepuklina pępkowa siatka polipropylenowa drenaż wodobrzusza ściana brzucha skala MELD chorobowość i śmiertelność niewydolność wątroby marskość wątroby cukrzyca wodobrzusze przepuklina pooperacyjna powikłanie pooperacyjne powikłanie śródoperacyjne powikłanie chirurgiczne wchłanialna zszywka laparoskopowa naprawa przepukliny brzusznej przepuklina pępkowa