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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Umbilical Hernia

I have a question about elective surgery specifically, umbilical herniorrhaphy in cirrhotic patients. Using the Child-Turcotte-Pugh (CTP) scoring method, I score a B or a C score. I m at 9 or 10 points depending on whether I get one point for no acites or two points for acites controlled with diuretics. I m on two diuretics but don t seem to notice any increased swelling my stomach when I go off them (I ll go off if I don t want to or it s inconvenient to urinate a lot.) However, if I choose acites controlled with diuretics, that puts me a 10 or level C on the CTP scale. With the severely increased mortality rate when a cirrhotic patient is at class C, I don t think it s a good idea for me to have surgery but my gastrointerologist said I can as does the surgeon. I m scheduled for next week and so far the hernia isn t incarcerated. What do you think?                                                   
Fri, 7 Nov 2014
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General Surgeon,  's  Response
HI.
This is a very typical situation where the balance between wisdom and necessity has to be decided. Particularly in a patient with bad CTP score to have a planned surgery for umbilical hernia.
This is not just a case of Surgery, you have to undergo stress of admission in a Hospital, anesthesia, will need medication of all sort like antibiotics, painkillers and so on. Cirrhosis does not allow many medicines to be taken as liver metabolizes them.
I would advise surgery only if the umbilical hernia is causing any symptoms of obstruction, other wise it should not be performed considering the risks which may outweigh the surgical benefits.
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Suggest Treatment For Umbilical Hernia

HI. This is a very typical situation where the balance between wisdom and necessity has to be decided. Particularly in a patient with bad CTP score to have a planned surgery for umbilical hernia. This is not just a case of Surgery, you have to undergo stress of admission in a Hospital, anesthesia, will need medication of all sort like antibiotics, painkillers and so on. Cirrhosis does not allow many medicines to be taken as liver metabolizes them. I would advise surgery only if the umbilical hernia is causing any symptoms of obstruction, other wise it should not be performed considering the risks which may outweigh the surgical benefits.