Combined treatment of refractory ascites with an alfapump® plus hernia repair in the same surgical session: A retrospective, multicentre, European pilot study in cirrhotic patients.

Nguyen-Khac, E; Sarba, R; Spahr, L; Staszewicz, W; DeGottardi, A.; Storni, F.; Elkrief, L; Dokmak, S; Valla, D; Pricope, D; Sabbagh, C; Regimbeau, J M (2021). Combined treatment of refractory ascites with an alfapump® plus hernia repair in the same surgical session: A retrospective, multicentre, European pilot study in cirrhotic patients. Journal of visceral surgery, 158(1), pp. 27-37. Elsevier 10.1016/j.jviscsurg.2020.06.003

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INTRODUCTION

The treatment of symptomatic hernia in cirrhotic patients with refractory ascites is critical but challenging. The objective of this study was to assess the feasibility and safety of the implantation of alfapump® combined with concomitant hernia repair in cirrhotic patients with refractory ascites.

METHODS

Using data from six European centres, we retrospectively compared patients treated with alfapump® system implantation and concomitant hernia repair [the combined treatment group (CT group, n=12)] or with intermittent paracentesis hernia repair [the standard treatment group (ST group, n=26)]. Some patients of the ST group had hernia repair in an elective setting (STel group) and others in emergency (STem group). The endpoints were requirement of peritoneal drainage, the rate of infectious complications, the in-hospital mortality, the length of stay, paracentesis-free survival.

RESULTS

Postoperatively, none of the patients in the CT group and 21 patients (80%) in the ST group underwent peritoneal drainage for the evacuation of ascites fluid (P<0.0001). The overall incidence of infectious complications was not different between groups but there were fewer infections in the CT group than in the STem group (33% vs. 81%; P=0.01). There was no difference for in-hospital mortality. The length of stay was shorter in the CT group (P=0.03). Paracentesis-free survival was significantly better (P=0.0003) in the CT group than in the ST group.

CONCLUSION

Implantation of alfapump combined with concomitant hernia repair seems feasible and safe in cirrhotic patients; however, larger and randomized study are required.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

De Gottardi, Andrea and Storni, Federico Lorenzo

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1878-7886

Publisher:

Elsevier

Language:

English

Submitter:

Rahel Fuhrer

Date Deposited:

15 Dec 2020 16:27

Last Modified:

02 Feb 2021 01:32

Publisher DOI:

10.1016/j.jviscsurg.2020.06.003

PubMed ID:

32553558

Uncontrolled Keywords:

Alfapump® Automated Cirrhosis Hernia Low flow Paracentesis Refractory ascites

BORIS DOI:

10.7892/boris.148414

URI:

https://boris.unibe.ch/id/eprint/148414

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