Paraumbilical Hernia Repair Research Articles

To mesh or not to mesh? A five year retrospective study evaluating patient perspective of mesh and non-mesh repair of umbilical and para-umbilical hernia

To mesh or not to mesh? A five year retrospective study evaluating patient perspective of mesh and non-mesh repair of umbilical and para-umbilical hernia

Mesh/Meshless Paraumbilical Hernia Repair with Concomitant Single-Incision Transumbilical Three-Port Laparoscopic Cholecystectomy—Prospective Observational Study of 126 Patients

Paraumbilical hernia with benign gallbladder disease forms a challenging combination for offering benefits of single-incision surgery. The purpose of this prospective observational study was to assess the outcomes of paraumbilical hernia repair performed concomitantly with three-port laparoscopic cholecystectomy through the same periumbilical incision using routine instruments. In total, 126 subjects formed the patient cohort. The mean age for females was 38.5 years, and that for the males was 40 years. The periumbilical curved incision accommodated three independent ports for conducting the cholecystectomy. The subsequent choice for the hernia repair was subject to the size (diameter) of the defect. Defects <4 cm in diameter (n=96) were suture-closed without mesh reinforcement. For defects 5-8-cm in diameter (n=33), an innovative technique of inserting all three ports directly into the peritoneal/hernial sac in a triangular manner was used for the cholecystectomy. Such a hernia defect was then reinforced with preperitoneal polypropylene mesh before closing it primarily after releasing the posterior rectus sheath. However, defects >8 cm were excluded from the study. The mean operative time was 75 minutes. Patients were discharged after a mean of 1.5 days. Four patients were converted to conventional laparoscopic cholecystectomy owing to technical difficulty. An umbilical seroma occurred in 3 patients. Over the mean follow-up of 38.5 months, none of the patients had paraumbilical hernia recurrence. A hernial sac was used to space out the ports. The morbidity of the procedure was acceptable. Concomitant paraumbilical repair and cholecystectomy by the technique described is effective and safe for select patients. Prosthetic reinforcement is advisable for hernia defects with a diameter of 5-8 cm.

Comparison between the short-term results of onlay and sublay mesh placement in the management of uncomplicated para-umbilical hernia: a prospective randomized study

The aim of this study was to compare between the short-term results of onlay and sublay mesh placement in the prosthetic repair of uncomplicated para-umbilical hernia (PUH). Eighty patients with a defect size ranging from 4 to 10 cm were prospectively randomized to either the onlay group (40 patients) or the sublay group (40 patients). The operative time, postoperative complications and short-term recurrence were reported. There were no statistically significant differences between both study groups as regards the patients' demographics, associated co-morbidities and mean defect size. The median operative time was significantly shorter in the onlay group compared to that in the sublay group (52 vs. 91 min respectively, p < 0.001). No statistically significant difference was found in the daily median pain score throughout the first postoperative week. The time required to remove the suction drain was significantly shorter in the sublay group compared to that in the onlay group (3 vs. 7 days respectively, p < 0.001).Complications were encountered in 4 patients (10%) in the onlay group compared to 3 patients (7.5%) in the sublay group (p = 1.000). Superficial wound infection was encountered in 1 patient (2.5%) in the sublay group, Seroma was encountered in 2 patients (5%) in the onlay group, Deep vein thrombosis was encountered in 1 patient (2.5%) in the onlay group, Chest infection was encountered in 2 patients (5%) in the sublay group compared to 1 patient (2.5%) in the onlay group. Throughout the 22 months median follow-up duration (range 6-42 months), 2 recurrences (5%) were encountered in either study group. Both techniques are safe, efficient and are associated with comparable complication and recurrence rates.

Local anaesthetic repair of uncomplicated paraumbilical Hernia without sedation: peri-operative pain and patient satisfaction

Paraumbilical hernia (PUH) is a common condition that usually requires surgical repair. However, there is a dearth of literature on this surgery performed under local anaesthesia (LA) without the use of sedation. The aims of this study were to assess peri-operative pain and patient satisfaction in patients undergoing PUH repair using LA without sedation. All patients having PUH repair under a single consultant between January 2010 and December 2011 were eligible to participate. If eligible for both, patients chose either general anaesthetic (GA) or LA repair. If only eligible for either LA or GA, they were offered this anaesthetic modality. Visual analogue scales were used to report peri-operative pain (10 point score) and satisfaction (%). Results were compared by grade of surgeon (higher surgical trainee (HST) versus consultant). A total of 63 patients underwent PUH repair (31 GA; 32 LA). Of them, only 28/32 of LA repair patients agreed to participate. LA and GA patients had equivalent age and sex distribution. LA patients had a lower body mass index (BMI) than GA [27.1 (3.7) versus 30.3 (5.1), p = 0.007]. The median length of LA procedure was 24 (17.5-30) minutes. The median LA solution infiltrated was 25 (20-32) ml. Peri-operative pain scores were low [1.1 (0.3-2.9) %] and patient satisfaction was high [96 (91-99) %]. There were no differences in pain, patient satisfaction, duration of procedure and amount of LA infiltrated with increasing BMI. Comparing HST to consultant, the former took longer [30 (25-36) versus 20 (16-24) minutes, p = 0.0007], infiltrated more LA [34.5 (26-47) versus 20 (19-25.5) ml, p = 0.0039], and patients reported more pain [2.75 (1.0-4.95) versus 0.4 (0.2-1.7) %, p = 0.029], but overall satisfaction was equivalent [95.5 (89-99.25) versus 96.3 (92.25-99) %, p = 0.684]. Open mesh PUH repair using LA without sedation is associated with low peri-operative pain and very high satisfaction when either a higher surgical trainee or a consultant grade is operating.

Same day discharge, surgical training and early complications after open and laparoscopic repair of primary paraumbilical hernia

The aims of this study were to compare same day discharges and early complications after open and laparoscopic primary paraumbilical hernia (PUH) repair, including the procedures performed by surgical trainees (STs). All patients who had open (suture or mesh) and laparoscopic repair of primary PUH in the Day Surgery Unit (DSU) between January 2007 and June 2009 were identified from the hospital database. The database was questioned regarding the grade of operating surgeon, type of surgical repair, day of admission and discharge from the DSU, and a patient's return to surgical services. Data were stored in Microsoft Excel(®) (TM 2007). Statistical significance was determined using Fisher's exact test. PUH was repaired in 337 patients: 252/337 (74.8 %) had open and 85/337 (25.2 %) had laparoscopic repair. Significantly, more patients were discharged home on the day of surgery after an open repair compared to the laparoscopic repair: open repair 187/252 (74.2 %), laparoscopic repair 35/85 (41.17 %), P = 0.0001. Overall early complications such as wound complications and hospital re-visits were similar in both groups: open repair 6.3 % (16/252), laparoscopic repair 11.7 % (10/85), P = 0.1554. STs performed 142/337 (42.1 %) of the PUH repairs with similar same day discharges from the DSU: STs 64.7 % (92/142), consultant surgeons 66.7 % (130/195), P = 0.7285. The difference in hernia recurrence between open repair 7/252 (2.78 %) and laparoscopic group 0/85 was not significant (P = 0.1985). Patients with PUH repair were more likely to go home on the day of surgery after open than after laparoscopic repair. This was not affected by the grade of the operating surgeon. Early complications were similar following open and laparoscopic repair of primary PUH.

Comparative Study between Laparoscopic and Open Repair of Paraumbilical Hernia

This randomized prospective study compared the effectiveness of laparoscopic paraumbilical hernioplasty to the conventional open technique. Forty patients with paraumbilical hernia were randomly categorized into 2 equal groups. GL treated by laparoscopic paraumbilical hernioplasty and GO treated by conventional (open) umbilical hernioplasty. The mean length of follow up was 36 months. In GL, mean operative time was 58.1 +/- 15.5 minutes, in GO, it was 42.2 +/- 10.3 minutes (p = 0.0005). Postoperative pain score 6 hours after surgery was 2.95 +/- 1.19 in GL patients as compared to 6.10 +/- 1.74 in GO ones (p < 0.0001). Mean hospitalization time was 1.05 +/- 0.224 days in GL versus 1.25 +/- 0.550 days in G O (p = 0.14). There was one conversion (5%) to the open repair. Postoperative seroma occurred in 2 patients (10%) in GL and 3 patients (15%) in GO. Three patients (15%) in G O developed surgical site infection. Hernia recurrence was not seen in either 2 Groups. Mean patient satisfaction score for GL patients was 7.85 +/- 1.27 versus 6.00 +/- 1.69 for GO patients (p = 0.0004). Compared to open repair, laparoscopic repair is technically feasible, safe and effective, with good clinical outcome. It is associated with longer time for surgery but reduced postoperative pain, analgesic requirement, complication and infection rates with earlier return to normal activities.

Peri-operative pain and patient satisfaction following open mesh repair of para-umbilical hernia under local anaesthesia: The west Suffolk experience

s / International Journal of Surgery 10 (2012) S1–S52 S5 ABSTRACTS Conclusions: Understanding thedynamic haematopoietic andmesenchymal contribution to ICC tumour formation informs therapeutic development. ASIT SHORT PAPER PRIZE: 0061: THE OPEN BLAST PELVIS: THE BURDEN OF MANAGEMENT Scott Evans, Arul Ramasamy, Jon Kendrew, Julian Cooper. University Hospitals of Birmingham, Queen Elizabeth, Birmingham, UK Aim: First study to evaluate casualties with an open pelvic blast injury. Methods: Retrospective study of a prospective combat trauma registry. UK Service Personnel sustaining open pelvic fractures from an explosive mechanism were identified from Aug 2008 Aug 2010. Results: 29 casualties survived with an open pelvic ring fracture following explosion. The median NIS score was 41. Mean blood requirements in the 1st 24 hours was 60.3 units. 6 casualties had an associated vascular injury, 7 had a bowel injury, 11 had a genital injury and 7 had a bladder injury. 8 fractures were managed definitively with external fixation, and 7 fractures required ORIF, with 4 requiring removal of metalwork for infection. Faecal diversion was performed on 9 casualties. Median length of stay was 70.2 days, and mean operative time was 29.6 hours. 1 casualty was managed solely by the orthopaedic team. 19 required at least three different surgical specialty input. At mean 20.3 months follow-up, 24 were able to ambulate, and 26 had clinical and radiological evidence of pelvic ring stability. Conclusions: Open blast pelvis represents the extreme end of trauma necessitating intense resource allocation. We do not feel faecal diversion is required in all cases. ASIT SHORT PAPER PRIZE: 0167 WINNER OF ASIT/ASGBI SHORT PAPER PRIZE: PERI-OPERATIVE PAIN AND PATIENT SATISFACTION FOLLOWING OPEN MESH REPAIR OF PARA-UMBILICAL HERNIA UNDER LOCAL ANAESTHESIA: THE WEST SUFFOLK EXPERIENCE Philip Bennett, Balendra Kumar, Eamonn Coveney. West Suffolk Hospital,

Is Surgical Training Excellent in the United Kingdom? – Preliminary Results of an Ongoing Prospective Survey

Is Surgical Training Excellent in the United Kingdom? – Preliminary Results of an Ongoing Prospective Survey

Mesh vs. Suture Repair of Para-Umbilical Hernias: A Systematic Review with Meta-Analysis

Mesh vs. Suture Repair of Para-Umbilical Hernias: A Systematic Review with Meta-Analysis

Paraumbilical hernia repair during cesarean delivery

BACKGROUND AND OBJECTIVES:Pregnant women with paraumbilical hernia usually postpone hernia repair until after delivery, but some patients request that it be done during cesarean delivery. Therefore, we evaluated the outcome of combined cesarean delivery and paraumbilical hernia repair in a prospective study at a tertiary referral university hospital.PATIENTS AND METHODS:In a prospective study, we compared the outcome of 48 patients undergoing cesarean delivery combined with paraumbilical hernia repair versus 100 low-risk patients undergoing cesarean delivery alone. The main outcome measures were operation time, blood loss, severity of pain, peripartum complications, hospital stay, hernia recurrence, and patient satisfaction.RESULTS:The combined procedure took significantly longer than cesarean delivery alone (75.2 minutes versus 60.5 minutes, P<.001)). There were no major complications. Wound infection occurred in 6 patients (4.1%). Hospital stay did not differ significantly from those of controls. Pain at the hernia site repair occurred in two patients, and one hernia recurred in the hernia repair group during a mean follow-up period of 22 months (range, 6-36 months). All hernia patients reported that they preferred the combined operation.CONCLUSIONS:Combined cesarean delivery and paraumbilical hernia repair had the advantage of a single incision, single anesthesia, and a single hospital stay while avoiding re-hospitalization for a separate hernia repair. Our results indicate that the combination approach is safe, effective, and well accepted.

PARAUMBILICAL HERNIA REPAIR DURING CAESAREAN SECTION; MATERNAL AND NEONATAL OUTCOMES

Design & Objectives : A prospective study to evaluate the outcome of combined caesarean section and paraumbilicalhernia repair in tertiary referral university hospital.Patients and methods: 48 patients undergoing caesarean section combined with paraumbilical hernia repair versus 100patients undergoing caesarean section alone.Main Outcome Measures: Operation time, Apgar Score, blood loss, uterine atony, breast feeding initiation, painsensation, peripartum complications, prolonged lochia (more than 42 days), deep venous thrombosis, hospital stay,hernia recurrence, and patient choice.Results: The combined procedure consumed significantly longer time than caesarean section alone in the meshhernioplasty subgroup. There were no major complications. Apgar Score, uterine atony, initiation of breastfeeding,prolonged lochia, wound infection and hospital stay did not differ significantly from those of controls. Pain at herniasite repair in two patients, one hernia recurred in the primary repair subgroup during follow up the period up to 3 years.All hernia group patients reported that they preferred the combined operation.Conclusion: Combined caesrean section and paraumbilical hernia repair had the advantage of single incision, singleanesthesia, and single hospital stay. The combination approach proved to tbe safte, effective, and well accepted.

A large encapsulated seroma presenting as a mass 5 years post paraumbilical hernia repair

Abdominoplasty is a procedure commonly performed by the modern reconstructive plastic surgeon, but despite its apparent routine nature complications are well documented in the literature and should be respected by even the most experienced plastic surgeon. Seroma is one of the most common complications known, however, most seromas usually occur within a few months following the primary procedure, are easily identifiable clinically as seroma and respond to simple aspiration, or resolve without any further intervention. We report the case of a 55-year-old female who presented with an unusual large abdominal mass 5 years following paraumbilical hernia repair and which was initially presumed to be an ovarian tumour. Following further investigation of this extensive mass, an abdominoplasty approach was used resulting in the removal of a large encapsulated seroma weighing over 5 kg and measuring 50 cm in length.

Retrospective comparison of mesh and sutured repair for adult umbilical hernias

Adult umbilical and paraumbilical hernia repair is associated with a high recurrence rate of 10-30%. Mesh repair has been reported to be associated with low recurrence rates. This study aims to compare sutured repair with prosthetic mesh repair to evaluate recurrence and infection rates. A retrospective study was conducted over an 8-year period including all the umbilical and paraumbilical hernia repairs performed by one consultant surgeon. The hernias were repaired using interrupted suture, Mayo overlap, flat mesh and mesh plug techniques. The study was based on case-note review, telephone and postal questionnaire survey. A total of 100 patients were studied, of which 70 had paraumbilical hernias, 28 had umbilical hernias and 2 had both types of hernia. Median age was 56 years (range 19-90 years). A total of 61 patients had suture repair (50 interrupted suture repair, 11 Mayo) and 39 had prosthetic mesh repair (33 mesh plug, 6 flat mesh). The median body mass index (BMI) was 31.2 (range 23.4-44.5) in the suture repair group and 33.3 (range 24.1-59.1) in the mesh group, with no significant statistical difference in BMI between the two groups (P>0.05). Median follow-up was 4.5 years (range 1-8 years). Recurrence rates for the suture and mesh repair groups were 11.5 and 0%, respectively (P=0.007). Infection rates for the suture and mesh repair groups were 11.5 and 0%, respectively (P=0.007). Our data suggest that prosthetic mesh repair is ideal for managing primary and recurrent umbilical hernias in both obese and non-obese patients.

Mesh plug repair for paraumbilical hernia

The standard method of repair of paraumbilical hernia (PUH) is by the Mayo technique, using a double-breasted flap of the rectus sheath. The reproducibility of this technique in the hands of others is highly variable. The present study describes and evaluates the application of a Prolene mesh plug in the repair of PUH. The use of a mesh plug in hernia repair is not a new concept with previous investigators yielding consistently excellent results in the repair of femoral and inguinal hernias. The study is a retrospective analysis of hospital records and telephone interviews of 34 patients having undergone PUH repair using the mesh plug technique in the period March 1998- May 2002. There were 20 males and 14 females with a median age of 53 years (range 34-86 years). Seventy-six percent (26) of the patient sample was obese (median BMI 33). Whenever possible local anaesthetic was used. Principal outcome measures studied were post-operative complications, recurrences, length of stay in hospital, post-operative analgesia, duration of drain, return to normal activities and patient satisfaction. Post-operative complications encountered included one case of seroma and a single wound infection with recurrence. Ninety-seven percent (32) of patients were satisfied with the procedure. Mesh plug repair can be performed with minimal postoperative complications, low recurrence rate, minimal post-operative pain and achieving excellent patient satisfaction. Prosthetic mesh plug repair under local anaesthetic could become the standard treatment for PUH in adults.

The rectus sheath block in paediatric anaesthesia: new indications for an old technique?

The rectus sheath block has been used with success for postoperative analgesia in adults. This paper reviews the anatomy of the rectus sheath, and presents our initial experience of using the block to provide intra- and postoperative analgesia in children having repair of umbilical and paraumbilical hernia. The rectus sheath block appears to be a useful technique in children, particularly for paediatric day-cases surgery.

Laparoscopic repair of paraumbilical ventral hernia with increasing size in an obese patient

Laparoscopic repair of paraumbilical ventral hernia with increasing size in an obese patient

MESH VERSUS SIMPLE ANATOMICAL REPAIR OF EPIGASTRIC AND PARAUMBILICAL HERNIAS

BACKGROUND: The standard method of repair of Para-umbilical hernia (PUH) and Epigastric herniais by the Mayo technique, using a double-breasted flap of the rectus sheath. The result of this techniquein the hands of others is highly variable. The present study describes and evaluates the comparison of aProlene mesh versus simple anatomical repair of (PUH) and Epigastric hernias. The use of a Prolenemesh in hernia repair is not a new concept with previous investigators yielding consistently excellentresults in the repair of Para-umbilical and Epigastric Hernias.OBJECTIVE: To compare the outcomes of the two modalities of surgical procedures (mesh versussimple anatomical repair) in terms of post-operative complications, hospital stay and rate of recurrencein two groups of Para-umbilical and epigastric hernia patients.MATERIAL AND METHODS: This comparative prospective study was conducted in the Departmentof Surgery Saidu group of teaching Hospital Saidu Sharif Swat KPK. One Hundred and Thirty twoconsecutive patients having large size, Para umbilical and epigastric hernia were included for the study,from Feb 2010 to Feb 2014 in two groups, 72 (group A) for mesh repair and 60 (group B) for simpleanatomical repair. All patients of these type hernias were admitted throughout patient department(OPD). Less than 4cm size hernia, Pregnant ladies, patients having strangulated hernia presented asemergency and patient unfit for general anesthesia were excluded from study.RESULTS: Majority of patients 63% belong to age of 35 to 60 years and 87 % were females. Supraumbilical swelling was the commonest presentation 80%.Cough impulse and reducibility was positive in90% of cases (some Epigastric hernias were irreducible). Contents of sac were omentum in 74% to 83%and small intestine 17% to 26%. Operative time was longer in group A (mesh repair) ranged from 60 to90 minutes while that was 50 to 70 minutes in group B (simple anatomical repair). Post-operativeevaluation took place after 2weeks then, 1, 2, 3months then 6monthly for 30 months (average 18months). The number of complications requiring treatment was the primary aim. There were threerecurrences observed in group A (4.16%) but six cases of group B (10%) presented with recurrence inwhich simple anatomical repaired was performed. The mean hospital stay for group A was 3.7 days andfor group B, 4.6 days.CONCLUSION: Mesh repair compare to simple anatomical repair, is with less hospital stay and lessrecurrence for Para umbilical and epigastric hernia having a defect of more than4 cm in leneaAlba.KEYWORDS: Para-umbilical hernia, simple repair, meshplasty, complications, recuurence.