Management and Outcomes of Umbilical Hernia in Decompensated Chronic Liver Disease: A Single-Unit Experience of Six Cases.

Background Complicated umbilical hernia in decompensated chronic liver disease is a significant cause of morbidity and mortality. This study evaluates the management strategies and factors predicting outcomes following emergency umbilical hernia repair. Methods A retrospective analysis was conducted on six patients with decompensated chronic liver disease who presented with complicated umbilical hernia in an emergency setting to the hepatopancreatobiliary (HPB) surgical unit between July and December 2024. Preoperative characteristics, intraoperative findings, and postoperative outcomes were reviewed. Results A total of six patients were included. The mean age was 51.16 years (range: 44-58), and all presented with abdominal pain (6, 100%). Among them, two (33.3%) presented with a strangulated umbilical hernia, two (33.3%) with an obstructed hernia, and two (33.3%) with a ruptured hernia associated with ascites fluid leak. All patients (6, 100%), underwent emergency surgery. Bowel resection was required in three (50.0%) patients, of whom two (33.3%) underwent primary anastomosis and one (16.7%) underwent a double-barrelled ileostomy. All six (100%) patients underwent primary repair of the hernial defect without mesh placement. Postoperative recovery was uneventful in four (66.7%) patients; one (16.7%) patient developed an ascites fluid leak, and one (16.7%) died. The mean postoperative hospital stay was 14.83 days. Conclusion Emergency repair of complicated umbilical hernia in patients with decompensated chronic liver disease is associated with high morbidity and mortality. Contributing factors include increased ascites, portal hypertension, and liver decompensation following surgery. Preoperative optimization and intraoperative ascites drainage may play a crucial role in improving outcomes, even in emergency settings.