{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:32:17Z","timestamp":1777447937674,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T00:00:00Z","timestamp":1672012800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Umbilical hernias (UHs) in cirrhotic patients are common, can be quite complicated and are associated with significant morbidity and mortality. Leakage of ascites is a challenging entity and poses significant risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective study of patients with cirrhosis and UHs with ascitic leakage. Patients were divided into two groups: patients managed operatively during index admission (Group 1) and those managed non-surgically during index admission (Group 2). Group 2 was further divided into those that subsequently underwent repair of UH and those managed medically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 47 cirrhotic patients with leaking UHs, 19 patients were managed surgically during index admission (Group 1). In Group 2, 15 patients were managed non-surgically and 13 subsequently underwent surgery. The groups had comparable demographics, MELD-Na and Child-Pugh class. Group 2 had a higher rate of emergency surgery (92% vs 58%, P = .04) and higher rate of recurrence (31 vs. 0%, P = .02). The non-surgical patients in Group 2 had higher 1-year mortality (67%) compared to Group 1 (21%) and surgical patients in Group 2 (31%, P = .007). Multi-variable logistic regression for 1-year mortality demonstrated MELD-Na as the most significant risk factor (OR = 1.2, P = .05) and undergoing UH repair as the most significant protective factor (OR = .16, P = .02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cirrhotic patients with leaking UHs should undergo urgent repair. Non-operative management confers high risk of continued or increased ascitic leakage necessitating more emergent surgery. Despite high rate of post-operative complications related to cirrhosis, there is a clear mortality benefit to the repair of leaking UHs in cirrhotic patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348221148362","type":"journal-article","created":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T14:56:12Z","timestamp":1672066572000},"page":"5365-5371","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Leaking Umbilical Hernias in Cirrhotic Patients, Repair or Observe?"],"prefix":"10.1177","volume":"89","author":[{"given":"Julia","family":"Torabi","sequence":"first","affiliation":[{"name":"Division of General Surgery, Mount Sinai Hospital, New York, NY, USA"},{"name":"Icahn School of Medicine at Mount Sinai, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sander","family":"Florman","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, New York, NY, USA"},{"name":"Mount Sinai Hospital, Recanati\/Miller Transplantation Institute, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celia","family":"Divino","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Mount Sinai Hospital, New York, NY, USA"},{"name":"Icahn School of Medicine at Mount Sinai, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,12,26]]},"reference":[{"key":"bibr1-00031348221148362","doi-asserted-by":"publisher","DOI":"10.1097\/SLE.0000000000000891"},{"key":"bibr2-00031348221148362","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003674"},{"key":"bibr3-00031348221148362","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2011.07.015"},{"key":"bibr4-00031348221148362","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2011.02.026"},{"key":"bibr5-00031348221148362","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31829e2313"},{"key":"bibr6-00031348221148362","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-008-0496-9"},{"key":"bibr7-00031348221148362","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v8.i7.476"},{"key":"bibr8-00031348221148362","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v27.i32.5297"},{"key":"bibr9-00031348221148362","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196101122640204"},{"key":"bibr10-00031348221148362","doi-asserted-by":"publisher","DOI":"10.3941\/jrcr.v9i9.2614"},{"key":"bibr11-00031348221148362","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/948172"},{"key":"bibr12-00031348221148362","first-page":"e23851","volume":"14","author":"Khatib 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