Feasibility of local anesthesia for treatment of uncomplicated umbilical hernia in patients with ascitic cirrhosis

Objective The aim of this study was to evaluate the effectiveness of local anesthesia in umbilical herniorrhaphy in patients having cirrhosis with controlled ascites. Background Umbilical hernia is a common abdominal wall complication of liver cirrhosis. The prevalence of umbilical hernia in patients having cirrhosis with ascites is up to 20%. Local anesthesia often provides maximum comfort for patients when it is accurately performed in open repairs. However, convincing evidence is lacking. Patients and methods This prospective study was carried out on 40 patients at Menoufia University Hospital and Damanhour Medical National Institute during the period from June 2016 till October 2017. All patients with cirrhosis with controlled ascites and uncomplicated umbilical hernia were included in this study. Exclusion criteria were complicated hernia, huge hernia, and local anesthesia hypersensitivity. All patients underwent elective umbilical herniorrhaphy under local anesthesia. Patients were followed up for 1 year. The complications and the outcome of the operation were recorded. Results Overall, 87.5% of patients passed without any complications, and 2.5% of them converted from local anesthesia to general anesthesia owing to omental injury (one patient). We inserted a surgical drain in 10% of patients. Most of patients (92.5%) were satisfied by this technique with different degrees of satisfaction, with 2.5% recurrence rate. Conclusion Umbilical herniorrhaphy under local anesthesia in patients with cirrhosis is feasible and safe, with a high success rate in experienced hands and results in minimal perioperative morbidity.