MESH VERSUS SIMPLE ANATOMICAL REPAIR OF EPIGASTRIC AND PARAUMBILICAL HERNIAS

Abstract

BACKGROUND: The standard method of repair of Para-umbilical hernia (PUH) and Epigastric hernia
is by the Mayo technique, using a double-breasted flap of the rectus sheath. The result of this technique
in the hands of others is highly variable. The present study describes and evaluates the comparison of a
Prolene mesh versus simple anatomical repair of (PUH) and Epigastric hernias. The use of a Prolene
mesh in hernia repair is not a new concept with previous investigators yielding consistently excellent
results in the repair of Para-umbilical and Epigastric Hernias.
OBJECTIVE: To compare the outcomes of the two modalities of surgical procedures (mesh versus
simple anatomical repair) in terms of post-operative complications, hospital stay and rate of recurrence
in two groups of Para-umbilical and epigastric hernia patients.
MATERIAL AND METHODS: This comparative prospective study was conducted in the Department
of Surgery Saidu group of teaching Hospital Saidu Sharif Swat KPK. One Hundred and Thirty two
consecutive 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 simple
anatomical 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 as
emergency 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. Supra
umbilical swelling was the commonest presentation 80%.Cough impulse and reducibility was positive in
90% 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 to
90 minutes while that was 50 to 70 minutes in group B (simple anatomical repair). Post-operative
evaluation took place after 2weeks then, 1, 2, 3months then 6monthly for 30 months (average 18
months). The number of complications requiring treatment was the primary aim. There were three
recurrences observed in group A (4.16%) but six cases of group B (10%) presented with recurrence in
which simple anatomical repaired was performed. The mean hospital stay for group A was 3.7 days and
for group B, 4.6 days.
CONCLUSION: Mesh repair compare to simple anatomical repair, is with less hospital stay and less
recurrence for Para umbilical and epigastric hernia having a defect of more than4 cm in leneaAlba.
KEYWORDS: Para-umbilical hernia, simple repair, meshplasty, complications, recuurence.