Outcomes of patients with chronic liver disease and symptomatic umbilical hernia presenting to a specialized liver transplant unit

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Abstract Aim Patients with chronic liver disease are predisposed to umbilical hernia due to ascites, sarcopenia, and abdominal wall weakness, with increased perioperative morbidity and mortality from the potential risk of liver decompensation. This study evaluates surgical outcomes of symptomatic umbilical hernia in chronic liver disease at a specialized liver transplant center. Materials and methods A retrospective observational study was conducted at Mahatma Gandhi Medical College and Hospital, Jaipur. Patients with symptomatic umbilical hernia and underlying chronic liver disease who underwent open umbilical herniorrhaphy after preoperative optimization from August 2021 to May 2024 were included. Severity of liver disease was assessed using Child–Turcotte–Pugh (CTP) and MELD-Na scores. Preoperatively, the risk of mortality was assessed using the Vocal-Penn score. Postoperative morbidity was graded by Clavien–Dindo classification (CDC) and outcomes included 90-day mortality and length of hospital stay. Results Thirteen patients (median age 55 years (IQR 41.5–62), 77% male) underwent surgery for symptomatic umbilical hernia. The most common etiology of chronic liver disease was alcohol-related (5 of 13 patients, 38.5%) and non-alcoholic steatohepatitis (NASH) (5 of 13 patients, 38.5%). Median preoperative CTP score was 9 (range 5–12) and MELD-Na score was 22 (range 8–29). All patients underwent open umbilical herniorrhaphy and two out of thirteen patients required bowel resection in view of bowel gangrene. Postoperative complications occurred in 8 of 13 patients (61.5%), and 5 of 13 patients (38.5%) experienced major complications (CD ≥ 3), including CD Grade IV ( n = 4) and Grade V ( n = 1). Postoperative MELD-Na score worsening was seen in 5 (38.4%) patients, of whom 4 patients recovered with appropriate care. The median hospital stay was 9 days (range 4–46), and 90-day mortality was 7.7%. Patients with preoperative Vocal Penn score with mortality risk of 32.6% had mortality. Median follow-up of these patients is 17.5 months. Conclusions Our study reaffirms that surgical repair of symptomatic umbilical hernia in decompensated liver cirrhosis patients can be performed with good outcomes when meticulous preoperative optimization and perioperative care is provided in a specialized liver transplant unit. This study with a small sample shows the feasibility of successful surgical outcomes for optimized, high-risk patients. Trial registration Clinical trial number is not taken because it is an observational study and a retrospective collection of data and approval was taken from the university institutional ethics committee (No: MGMC&H/IEC/JPR/2025/4994).

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