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.	楊世煒, 王永, 伍兵, 等. 無張力疝修補術治療腹股溝疝合并腹腔積液的臨床療效. 中華消化外科雜志, 2017, 16(9): 911-914.
7.	李瑛, 胡振斌, 徐昆, 等. 中醫藥治療肝硬化腹水臨床研究概述. 中西醫結合肝病雜志, 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.	張傳寶, 張敬坡, 馮雷, 等. 局部神經阻滯麻醉下無張力疝修補術在肝硬化腹水合并腹股溝疝患者中的應用. 中華疝和腹壁外科雜志(電子版), 2016, 10(6): 414-416.
10.	李曉斌, 吳孟闈, 劉睿, 等. Lichtenstein 手術治療肝硬化腹水合并腹股溝疝的臨床療效. 中華消化外科雜志, 2019, 18(11): 1027-1031.
11.	王華強, 謝芳, 盛云峰, 等. 肝硬化患者發生血流感染的影響因素和病原學特點. 肝臟, 2021, 26(3): 252-254, 258.
12.	湯佳音, 羅蒙, 施志強, 等. 腹股溝疝合并肝硬化的治療分析: 附 30 例報告. 中國普通外科雜志, 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, 郝學超, 閔蘇. 日間手術的實施流程及標準. 臨床麻醉學雜志, 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, 盧爽, 等. 我國日間手術研究現狀與分析. 全科護理, 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.	孫丕絳, 蔡超, 于燕華, 等. 腹腔鏡與開放手術治療肝硬化合并腹股溝疝的臨床對照研究. 國際醫藥衛生導報, 2021, 27(17): 2671-2675.
21.	羅怡君, 趙靈悅, 劉宏玥, 等. 日間手術預住院統一管理模式的建設和實踐探討. 中國衛生標準管理, 2024, 15(2): 62-65.
22.	儲愛琴, 葛文杰, 張海玲, 等. “互聯網+”預住院服務模式應用現狀及影響因素分析. 中國醫院管理, 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.	馬熙, 劉曉江. 疝環充填式無張力疝修補術在肝硬化腹水患者中的應用. 臨床外科雜志, 2007, 15(3): 180.
30.	羅國德, 曹永寬, 張林, 等. PHS 術式治療腹股溝疝合并肝硬化腹水的臨床觀察(附 8 例報告). 安徽醫學, 2012, 33(6): 697-698.
31.	魏振滿, 張文瑾. 肝化腹腔感染抗生素應用的流行病學分析. 中國抗生素雜志, 1999, 24(3): 229-230.
32.	曲芬, 毛遠麗, 崔恩博, 等. 肝炎及肝硬化患者葡萄球菌屬的分布及耐藥性. 中國抗生素雜志, 2005, 30(2): 91-93.
33.	卜昕, 曲芬, 蔡少平, 等. 肝病患者氣單胞菌敗血癥 90 例臨床特征及轉歸. 中國抗生素雜志, 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.	中華醫學會消化病學分會. 中國肝硬化臨床診治共識意見. 臨床肝膽病雜志, 2023, 39(9): 2057-2073.
36.	中華醫學會外科學分會疝與腹壁外科學組, 中國醫師協會外科醫師分會疝和腹壁外科醫師委員會. 成人腹股溝疝診斷和治療指南(2018 年版). 中華胃腸外科雜志, 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. 楊世煒, 王永, 伍兵, 等. 無張力疝修補術治療腹股溝疝合并腹腔積液的臨床療效. 中華消化外科雜志, 2017, 16(9): 911-914.
7. 李瑛, 胡振斌, 徐昆, 等. 中醫藥治療肝硬化腹水臨床研究概述. 中西醫結合肝病雜志, 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. 張傳寶, 張敬坡, 馮雷, 等. 局部神經阻滯麻醉下無張力疝修補術在肝硬化腹水合并腹股溝疝患者中的應用. 中華疝和腹壁外科雜志(電子版), 2016, 10(6): 414-416.
10. 李曉斌, 吳孟闈, 劉睿, 等. Lichtenstein 手術治療肝硬化腹水合并腹股溝疝的臨床療效. 中華消化外科雜志, 2019, 18(11): 1027-1031.
11. 王華強, 謝芳, 盛云峰, 等. 肝硬化患者發生血流感染的影響因素和病原學特點. 肝臟, 2021, 26(3): 252-254, 258.
12. 湯佳音, 羅蒙, 施志強, 等. 腹股溝疝合并肝硬化的治療分析: 附 30 例報告. 中國普通外科雜志, 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, 郝學超, 閔蘇. 日間手術的實施流程及標準. 臨床麻醉學雜志, 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, 盧爽, 等. 我國日間手術研究現狀與分析. 全科護理, 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. 孫丕絳, 蔡超, 于燕華, 等. 腹腔鏡與開放手術治療肝硬化合并腹股溝疝的臨床對照研究. 國際醫藥衛生導報, 2021, 27(17): 2671-2675.
21. 羅怡君, 趙靈悅, 劉宏玥, 等. 日間手術預住院統一管理模式的建設和實踐探討. 中國衛生標準管理, 2024, 15(2): 62-65.
22. 儲愛琴, 葛文杰, 張海玲, 等. “互聯網+”預住院服務模式應用現狀及影響因素分析. 中國醫院管理, 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. 馬熙, 劉曉江. 疝環充填式無張力疝修補術在肝硬化腹水患者中的應用. 臨床外科雜志, 2007, 15(3): 180.
30. 羅國德, 曹永寬, 張林, 等. PHS 術式治療腹股溝疝合并肝硬化腹水的臨床觀察(附 8 例報告). 安徽醫學, 2012, 33(6): 697-698.
31. 魏振滿, 張文瑾. 肝化腹腔感染抗生素應用的流行病學分析. 中國抗生素雜志, 1999, 24(3): 229-230.
32. 曲芬, 毛遠麗, 崔恩博, 等. 肝炎及肝硬化患者葡萄球菌屬的分布及耐藥性. 中國抗生素雜志, 2005, 30(2): 91-93.
33. 卜昕, 曲芬, 蔡少平, 等. 肝病患者氣單胞菌敗血癥 90 例臨床特征及轉歸. 中國抗生素雜志, 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. 中華醫學會消化病學分會. 中國肝硬化臨床診治共識意見. 臨床肝膽病雜志, 2023, 39(9): 2057-2073.
36. 中華醫學會外科學分會疝與腹壁外科學組, 中國醫師協會外科醫師分會疝和腹壁外科醫師委員會. 成人腹股溝疝診斷和治療指南(2018 年版). 中華胃腸外科雜志, 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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