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

Eric Nguyen-Khac (1, 2) , R. Sarba , L. Spahr , W. Staszewicz , A. Degottardi , F. Storni , L. Elkrief , S. Dokmak (3) , D. Valla (4) , D. Pricope (5) , Charles Sabbagh (1, 6) , Jean-Marc Regimbeau (1, 6)

1 CHU Amiens-Picardie
2 GRAP - Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247
3 Service d’Hépatologie [Hôpital Beaujon]
4 CEA-CESTA - Commissariat à l'Energie Atomique et aux Energies Alternatives
5 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
6 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518

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 (R) 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 (R) 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. (C) 2020 Published by Elsevier Masson SAS.

Domaines: Sciences du Vivant [q-bio]

Eric Nguyen-Khac, R. Sarba, L. Spahr, W. Staszewicz, A. Degottardi, et al.. Combined treatment of refractory ascites with an alfapump (R) plus hernia repair in the same surgical session: A retrospective, multicentre, European pilot study in cirrhotic patients. Journal of Visceral Surgery, 2021, 158 (1), pp.27-37. ⟨10.1016/j.jviscsurg.2020.06.003⟩. ⟨hal-03590854⟩