Umbilical herniorrhaphy in cirrhotic patients.

During a ten-year period, 92 patients underwent an umbilical herniorrhaphy. Patients were divided into three groups: group 1, cirrhotic patients with ascites with functioning peritoneovenous shunts (n = 15); group 2, cirrhotic patients with ascites with nonfunctioning or no peritoneovenous shunts (n = 24); and group 3, noncirrhotic patients (n = 53). The charts were analyzed for postoperative mortality and morbidity and recurrence of the umbilical hernia. Umbilical hernia in cirrhotic patients with uncontrolled ascites was associated with significant mortality (8.3%) and morbidity (16.6%) and a significantly greater incidence of recurrence (16.6%). Umbilical herniorrhaphy in patients with functioning peritoneovenous shunts was associated with minimal morbidity (7%). These data suggest that cirrhotic patients with ascites who require an umbilical herniorrhaphy preferably should undergo peritoneovenous shunting before repair of the hernia.

Feeding gastrostomy: a reappraisal.

A retrospective review of 67 patients undergoing feeding gastrostomy for nutritional support over a ten-year period disclosed a 30 day mortality rate of 30 per cent following this procedure. Patients with head and neck carcinoma and those patients who were not in coma at the time of the procedure enjoyed extended and useful long-term survival. Patients who were in coma at the time of the procedure had similar mortality rates, but no patient ever regained consciousness afterward despite survival times of over one year. It is our conclusion that feeding gastrostomy in comatose patients is a questionable procedure and one which is unlikely to benefit the patient. It would appear that the only present day rationale for the performance of a feeding gastrostomy in comatose patients lies in the facilitation of their nursing care and their transfer to a chronic care facility.