الفهرس 
I. IntroductionOnly 14 pages are availabe for public view
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Abstract
In cirrhosis, ascites mainly occurs due to portal hypertension and splanchnic vasodilation as a result of increase production of nitric oxide. Infection increases mortality in cirrhosis four times and has a poor prognosis, with 30% of patients dying within a month of infection and another 30% within a year.
Hernia in patients with liver cirrhosis is due to a combination of factors such as increased abdominal pressure by the presence of tense ascites , fascial and muscular structures weakness because of nutritional status. The prevalence of umbilical hernia in cirrhotic patients with ascites is up to 20% and recurrence rate as high as 60% after surgical correction has been reported.
The control of ascites in cirrhotic patients presents a further dilemma and it uncontrolled negatively influence recurrence rates and morbidity rates. Elective umbilical herniorrhaphy is the standard treatment in the general population. Optimizing the patients with liver cirrhosis before elective umbilical hernia repair is crucial to minimizing postoperative complications and reducing recurrence.
All types of anaesthesia (local, general, and spinal) are suitable in most cases. However, some centers routinely use local anesthesia for those patients. Local anaesthesia may also be challenging if the patient is obese and hernia is large and/or recurrent. Recurrence of umbilical hernia in cirrhotics with ascites ranging between 0 to 60% So, effective management of ascites is essential to achieve umbilical hernia repair success as well as to reduce recurrence rate.
The aim of this work was to evaluate the feasibility of using local anaesthesia for treatment of uncomplicated umbilical hernia in cirrhotic patients with ascites. Our prospective study was carried out on 40 patients at Menoufia University Hospital (Shebin El-Kom) and Damanhour Medical National Institute (El-Beheira). The amount of anaesthetic that admitted ranged between 20-50 ml of xylocain 2% and thirty-six of the patients (90%) were compliant with this type of anaesthesia ”local, regional”.
We used the visual analogue score for assessing the degree of pain feeling of patients after the operation. The operative time ranged between 35-60 min with a mean value of 42.7 min with thirty-one case pass smoothly without complications. And only one of our patients (2.5%) was converted from local anesthesia to general anesthesia.
In our patients we put a surgical drain in the wound in 10% of cases and the period of the drain ranged between 3 to 7 days with a mean period from 4 to 6 days. Most patients of our study (92.5%) were satisfied by our technique with different degrees of satisfaction. During the early post-operative period we had (22.5%) complication rate in the form of severe skin infection (5%), ascitic fluid leak from the wound (2.5%) and wound hematoma (12.5%). While during the follow-up period of one year, we had 5% recurrence rate due to wound dehiscence and uncontrolled ascites.
from our study we can conclude that the use of local anaesthesia for the treatment of uncomplicated umbilical hernia in cirrhotic patients with controlled ascites is a safe and compliable technique. So, we recommended its use especially in cases of severe degrees of cirrhotic patients that suspected to have serious complications if they had general anaesthesia due its effect on the liver.