Concurrent hysterectomy and umbilical hernia repair via transvaginal notes among morbidly obese patients

Ayhan Cevik,Betul Kuru,Emre Mat,Hasan Fehmi Küçük,Mehmet Mustafa Altintas,Selcuk Kaya

doi:10.31083/j.ceog4901030

Abstract

Background: Umbilical hernias are especially common along with overweight, multiparous women. Laparoscopic hernia repair is preferred due to many advantages. On the other hand, the risk of trocar site hernia is disadvantageous. Trocars do not go through the abdominal wall via transvaginal natural orifice transluminal endoscopic surgery (V-NOTES). We investigate the V-NOTES hysterectomy and concomitant umbilical hernia repairment feasibility and outcomes. Methods: Six morbidly obese patients underwent V-NOTES hysterectomy and concurrent umbilical hernia repair between April 2020 and January 2021. Demographic features of patients, operating time, hernia size, complications, hospitalization time, recurrence of the hernia, visual analog scale (VAS) at 6th, 12th, and 24th hours, first, fourth, 12th weeks, and sixth months were recorded. Results: The average age of patients was 47.667 ± 2.422 (45–52). Mean body mass index (BMI), hernia and operating time size were 44.367 ± 3.217 kg/m2 (40.3–48.5), 6.167 ± 1.722 cm (4–9) and 88 ± 12.791 minutes (75–110), respectively. Intraoperative complications did not occur. Seroma was detected in one patient(16.6%). In six month follow-up period, we did not establish a diagnosis of hernia recurrence and postoperative chronic pain. Conclusion: Our study offers a novel perspective on V-NOTES umbilical hernia repair and hysterectomy in morbidly obese patients. According to our study, performing V-NOTES umbilical hernia repairment in a risky patient population is feasible and has promising outcomes.

Highlights

2% of the population of the world has a clinically demonstrable umbilical hernia [1]
We aim to describe the concurrent via transvaginal natural orifice transluminal endoscopic surgery (V-natural orifice transluminal endoscopic surgery (NOTES)) hysterectomy and umbilical hernia repair technique among morbidly obese patients and present the short- and long-term surgical outcomes of this surgery
Inclusion criteria for patients were: age between 35– 70 years, body mass index (BMI) higher than 40 kg/m2, hysterectomy planned for benign pathologies, no history of hernia operation, symptomatic umbilical hernia, no mental problems to evaluate the visual analog scale (VAS) and willingness to participate in the study

Summary

Introduction

2% of the population of the world has a clinically demonstrable umbilical hernia [1]. The characteristics of an umbilical hernia patient are frequently overweight, multiparous female between her fourth and sixth decade [3]. In five years of a watchful waiting period, there is a 16% probability of patients with umbilical hernias requiring surgery and a 4% chance of requiring emergency surgery [5]. We investigate the V-NOTES hysterectomy and concomitant umbilical hernia repairment feasibility and outcomes. Methods: Six morbidly obese patients underwent V-NOTES hysterectomy and concurrent umbilical hernia repair between April 2020 and January 2021. Conclusion: Our study offers a novel perspective on V-NOTES umbilical hernia repair and hysterectomy in morbidly obese patients. According to our study, performing V-NOTES umbilical hernia repairment in a risky patient population is feasible and has promising outcomes

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