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Category: Volume 06 Issue 08 August 2018
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Title: Surgical Management of Umbilical and Paraumbilical Hernia in Adults

Authors: Dr Dharmendra.B.L, Dr Vijaykumar. N

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i8.84

Abstract

This was a Prospective observational study of umbilical and paraumbilical hernias in adults. It included patients admitted with umbilical and paraumbilical hernias to the surgical wards from November 2015 to October 2017.

60 patients were selected for the study, of which 36 were females and 24 were males. 6 patients underwent Mayo repair and 35 patients underwent Onlay Mesh repair and 19 patients underwent Sublay mesh repair. The follow up period was between 6 months to 22 months (avg 12 months).

In the study period, 60 cases of umbilical and paraumbilical hernias were operated, out of which 32 were umbilical hernias and 28 were paraumbilical hernias.

Swelling and pain were the most common modes of presentation. The mean BMI of all patients was 25.7. This substantiates the fact that obesity is a major risk factor in development of these hernias.

Most of the females were multiparous increasing the risk of development of hernia.

Peroperatively, omentum was the most common content with most cases having adhesions at the neck of the sac.

Observations made during the study in the management were: Postoperative incidence of seroma, wound dehiscence and wound infection was higher in Onlay repair and lesser in sublay repair. Hospital stay was lesser in sublay mesh repair along with patient satisfaction. Recurrence was noted in Mayo repair while no recurrence was reported in Mesh repair.

Keywords: Umbilical hernia, Paraumbilical hernia, Mesh repair, Mayo repair.

References

  1. Olch PD, Harkins Historical survey of treatment of inguinal hernia. In: Nyhus LM, Harkins HN, eds. Hermia. Phila delphia : JB Lippincott Co., 1964:1.
  2. Walker The natural History of umbilical hernia. A six year follow up of 314 negro children with this defect. Clin Pediatr (Phila) 1967:6:29-32.
  3. On surgery and instruments. A definitive edition of the Arabic text with English translation and commentary by MS Spink and GL Lewis. London: The well come institute of the History of Medicine and The oxford university press, 1973.
  4. Ellis The umbilical hernia of Queen Caroline. Contemp surg 1980;17:83.
  5. W.J. An operation for the radical cure of umbilical hernia. Ann surg 1901 ; 34; 276.
  6. Volker S, Vwek, Bernd Biomaterials for the repair of abdominal wall. In: Nyhus LM, Condon RE, eds Hernia 4th ed. Philadelphia: JB Lippincott Co., 1995 : 319.
  7. Askar Aponeuratic hernias. Recent observation upon epigastric and paraumbilical hernias. Surg clinics of North America 1984;64:315.
  8. TS. Embryology, Anatomy and diseases of the umbilicus together with diseases of urachus. Philadelphia : WB Saunders, 1916:1.
  9. Bergsmand D, Birth defects compendium, ed. New York : Alna R Liss, 1979.
  10. Orda R, Nathan H, Surgical Anatomy of the umbilical Int. Surg
  11. Bailey and Love’s Short practice of Surgery. 26th Norman S Williams, Christopher J. K Bulstrode, P. Ronan O’ Connell.
  12. Leonetti et Umbilical herniorrhaphy in cirrhotic patients. Arch of Surgery 1984;119.
  13. Blumberg Infantile Umbilical hernia. Surg Gynaecol Obstet 1980;150:187.
  14. Mack The incidence of umbilical herniae in Africans. East Afr Med J 1945; 22:369.
  15. Jackson OJ, Moglen Umbilical hemia : a retro-spective study. Calif Med
  16. Woods Some observations on Umbilical hernia in infants. Arch Dis child.
  17. Crump Umbilical hernia. I. Occurrence of the infantile type in Negro infants and children. J. paediatr 1952;40:214.
  18. Vohr BR, Rosen field AG, Oh Umbilical hernia in the low birth weight infant (less than 1500g). J Pediatr, 1997;90:807-808.
  19. Current concepts on adult umbilical M. Velasco, M. A. Garcia-Urefia, M. Hidalgo, V. vega and F. J. Camero. Hemia.V01 3.N0 4.233-239.
  20. Arroys et Randomised clinical trial comparing suture repair and mesh repair of adult umbilical hernia BJS 1321-1323.
  21. Radhakrishnan Umbilical hernia. In : Nyhus CM, Condon RE Eds. Hernia, 4th edition, Philadelphia: JB Lippincott Co, 1995, 361
  22. Joseph Penda MD. Hernias of the Abdominal wall. WB Saunders company. Philadelphia, London
  23. Jack Hernias Maingot's Abdominal operations. 10th edition; 14:479-580.
  24. Goldie khera, David A Berstock .Incisional, epigastric and umbilical hernia repair using th prolene hernia system: describing a novel Hernia.2006.V01 10,No 4,367-369.
  25. Goldstein Selecting the right mesh. Hernia 1999 : 23-26.
  26. Fischer’s Mastery of Surgery 6thEdition Josef Fischer
  27. A Halm, J. Heister kamp, H. F . Veen and W. F. Wedema, “ long term followup after umbilical hernia repair: Are there risk factors for recurrence after simple and mesh repair” Hernia Vol 9, 2005, pp. 334-337
  28. A. Jacobus, R. W. Luijendijk, W. C. J. Hop, J. A. Halm, E. G. G. Verdaasdonk andJ. Jeekel “Long term followup of a Randomised controlled study of suture versus mesh repair of Incisional hernia,” Annals of Surgery . Vol 240, NO.4, 2004, pp 518- 583.
  29. Sanjay, T. D. Reid, E. L. Davies, P. J. Arumugam and A. Woodward, “A retrospective comparison of mesh and sutured repair for Adult umbilical Hernia, Vol 9, No. 4, 2005, pp. 248- 251
  30. Eryilmaz .R, M “which repair in Umbilical hernia of adults : Primary orr mesh ?” International surgery Journal 2006, 91 : 258-261.
  31. Arroyo et al, “Mesh versus suture repair for Umbilical hernia, a prospective randomized clnical trial comparing suture and mesh repair of Umbilical hernia in adults “British Journal of Surgery. Vol 88, No.10, 2001, pp 1321-1323.

Corresponding Author

Dr Vijaykumar. N

Department of Plastic Surgery

Mysore Medical College and Research Institute, Irwin Road. Mysore