Can Patients with Cirrhosis and Ascites Undergo Hernia Surgery?

Patients suffering from cirrhosis and ascites may still be eligible for hernia surgery, although the decision must be made carefully due to increased risks. Hernias—especially inguinal and umbilical types—are common in individuals with liver disease and fluid buildup in the abdomen. While surgery remains the only definitive treatment for hernias, patients with cirrhosis face higher surgical risks and a greater chance of recurrence.

What Conditions Make Hernia Surgery Feasible?

For patients with cirrhosis and ascites, certain criteria must be met before proceeding with surgery:

- Liver function should be stable or near normal, ideally with ALT levels below 100 and minimal or no jaundice. Serum albumin should be above 30g/L.
- Large-volume ascites is not suitable for surgery; however, minor fluid accumulation may be manageable.
- Platelet count should be at least 50×10^9/L to reduce the risk of excessive bleeding during and after the procedure.

Is Laparoscopic Mesh Repair an Option?

In cases where the patient's overall condition meets the ASA physical status classification of 1–2, laparoscopic hernia repair with mesh may be considered. This requires proper preoperative management including optimizing liver function, minimizing ascites, and ensuring adequate platelet levels. Key procedural considerations include maintaining low intra-abdominal pressure, meticulous dissection, thorough hemostasis, and secure closure of the peritoneum. A pelvic drain may be placed if necessary.

Despite meeting these conditions, patients with cirrhosis and ascites remain at high risk for complications. Poor liver function can impair wound healing, while persistent ascites increases intra-abdominal pressure, raising the likelihood of hernia recurrence. Additionally, coagulopathy and immune compromise due to hypersplenism can lead to infections and other postoperative challenges.

In summary, while hernia surgery is possible for patients with cirrhosis and ascites under specific conditions, careful evaluation and multidisciplinary planning are essential to ensure the best possible outcomes.