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Treatment of umbilical hernia in patients with refractory ascites due to cirrhosis is associated with a high risk of postoperative complications. Control of ascites must accompany and follow surgery in order to ensure adequate postoperative healing. The alfapump system is an innovative, rechargeable, fully implantable, automatic low-flow pump placed subcutaneously in the abdominal wall which automatically moves ascites from the peritoneal cavity to the bladder, thus decreasing or eliminating the need for paracentesis. We report the cases of two cirrhotic patients with both refractory ascites and large umbilical hernia who underwent repair of the umbilical hernia at the same time as alfapump system implantation. Implantation of the alfapump system resulted in control of ascites, improvement of nutritional status and quality of life, and no recurrence of the hernia. Combining implantation of the alfapump system with surgical repair of the umbilical hernia is offered as a possible solution to this therapeutic challenge.

Combined treatment of refractory ascites by alfapumpTM and surgical umbilical hernia repair in cirrhotic patients: Is this the right paradigm?