Treatment of Ventral Hernia in Patients with Liver Cirrhosis (MELD Score Below 15)

Umbilical and epigastric hernias occur at elevated rates in patients with liver cirrhosis, particularly those with associated ascites. When the Model for End-stage Liver Disease (MELD) score is below 15, a structured surgical approach — following hepatic optimisation — is the recommended path.

Clinical scenario

Umbilical or epigastric hernia in a patient with liver cirrhosis and a MELD score below 15. The underlying hepatic disease shapes both the timing and technique of repair.

Treatment approach (partial)

The protocol recommends elective hernia repair after preoperative optimisation of liver function, using a specific open surgical technique with mesh placement.

Full surgical guidance — including repair method, mesh positioning, and perioperative considerations — is in the complete protocol.

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References

DOI: 10.1002/bjs5.50252

Umbilical hernia is seen frequently in patients with cirrhosis and associated ascites, with a reported incidence of 20 per cent.

It is suggested to offer elective umbilical or epigastric hernia repair after optimization of liver function in patients with liver cirrhosis (MELD score below 15).

It is suggested to use an open repair with onlay or preperitoneal mesh for umbilical or epigastric hernias in patients with compromised liver function.

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