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Cirrhosis of the Liver Community
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Non operative Hernia's

My partner was diagnosed 11 months ago with cirrhosis when complaints about hernia arose. He is being treated for ascites and varices. The cirrhosis symptoms have improved except ascites which is not getting worse.
The problem seems to be that they will not do the hernia operation because of the mortality rate, and ascites. Hernias are huge and quiet a problem with movement. My partner has to mostly lay on the couch with short duration of exercise.
He is under 50 yrs and drank for years but not touched it for 7 months. Has anyone else been refused hernia operations? Does a person have to wait until strangulation occurs and risks are higher? What's a person to do? We have spent hundreds of dollars on different support systems for the hernia's so movement is tolerated to no avail. Depression is setting in for him as he thinks he has no control over the situation. Any suggestions and experiences? Thank-you for a response in advance
3 Responses
446474 tn?1446347682
COMMUNITY LEADER
Has anyone else been refused hernia operations?
-All of us who have had hernias from ascites due to advanced cirrhosis have had to wait until our cirrhosis was resolved before our hernias were address. This is standard medical practice.

- The main medical issue is that your partner has advanced cirrhosis. They are not only at an increased risk for complications from any surgery (particularly from infection) but there is little point in trying to repair a hernia while a person still has ascites. Beside the risks of the surgery itself it is very likely to hernia recur any way. The point is to treat the cause of the hernia. The person’s advanced, life-threatening cirrhosis.

Does a person have to wait until strangulation occurs and risks are higher?
- Strangulation is a rare occurrence but it can happen and you and your partner should be aware of the signs of strangulation. Should it occur you should immediacy go to the nearest ER. I had a total strangulation of my bowel due to a hernia I had for 5 years as a complication of my ascites. Luckily I had excellent treatment and my bowels started working again after about 5 days. I was then able to get my liver transplant and had my hernia repaired after my transplant when there is no more risk of ascites.

What's a person to do?
-I would recommend learning more about cirrhosis (the real medical issue which causes ascites, varices and many other serious complications) and how to best manage them. Ascites is a very manageable condition with proper diet, diuretics or paracentesis.

Advanced cirrhosis is a life-threatening disease. A hernia is a very minor complication of cirrhosis. You focus should be on the cirrhosis. Once the cirrhosis is managed (either by the cirrhosis reversing because the cause of the cirrhosis, alcohol, has been removed or by liver transplant if the cirrhosis has gone too far and is irreversible) then the hernia can be addressed.

Talk to the liver doctor to learn how you both can learn to manage the cirrhosis and its complications. Many of us have many lived years with ascites and hernias. It is part of learning to live with advanced cirrhosis until we overcome our liver disease.

I hope this helps.
Hector
Avatar universal

Thank you so much for your reply. Your info was very helpful and reassuring. I will continue to do the researching and figure out a way to control the ascites with diet and salt.
The info on this site is very informative. Hard to believe so many people suffer with this disease from so many different causes. Respect to you all, especially to those who share their experiences, and your knowledge of the road already traveled. Thank-you for sharing.
446474 tn?1446347682
COMMUNITY LEADER
I am glad I could help.
Myself and many of my friends have had similar experiences with our ascites. While cirrhosis and most of its complications can be managed with due diligence it is no easy road. Cirrhosis and its complications has lots of ups and downs and you just have to do the best you can and try no to get overwhelmed by it all.

Ascites can usually be controlled at least up until the liver disease becomes very bad (End-Stage Liver Disease and a MELD score typically in the mid 20s and above). At that point the person will need a liver transplant soon to continue to survive. At that point, only periodic paracentesis can manage the fluid build up.

The First-Line of treatment for ascites is sodium/salt restriction. A person MUST restrict their sodium intake to less that 2000 mg per day for ascites to be controlled. If this is not done first and foremost, diuretics will not be able to control the fluid build up. This means no adding salt to food. I got rid of m salt shaker years ago and even though I can now have salt after my transplant I have no desire too. There is plenty of sodium naturally in foods.

You need to start looking at labels.You will notice that most processed foods have tons of sodium. One can of regular soup can equal a whole days sodium supply. It is best to eat real foods. Fruits and vegetables. If you make it yourself then foods won't have all of the sodium companies add to "make it taste good". Luckily these days there are more and more low sodium options but you must check the label as some "low sodium" are not really that low.

Once the sodium is under control then it is a matter of getting the right dosages of diuretics. Usually Spironolactone and Furosemide (Lasix) are used to manage ascites. The doctor should tweak the doses in balance so it is effective in managing the amount of fluid build up. If the person gains more than a certain number of lbs in a certain number of days then you know the doses should be increased.

The doses of both oral diuretics can be increased simultaneously by the doctor every 3 to 5 days (maintaining the 100 mg:40 mg ratio) if weight loss is inadequate. Usual maximum doses are 400 mg per day of spironolactone and 160 mg per day of furosemide.

It takes time to learn how to best manage ascites or any other complication of cirrhosis while we have it. All of our bodies are a little different but once you get the diet and diuretics right you should see an improvement in the quality of life which makes dealing with cirrhosis and its complications a little bit easier.

Take care.
Hector
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