Umbilical Hernia in Cirrhotic Patients : Outcome of Elective Repair (original) (raw)
Related papers
Current concepts on adult umbilical hernia
Hernia, 1999
Umbilical hernia has not received as much attention as other abdominal wall defects. Prevalence in the adult population is 2% and is much more common in cirrhotic patients and obese middle-aged multiparous women. Adult umbilical hernias have an acquired origin as a consequence of increases in pressure (pregnancy, ascites, etc.), the pull of the abdominal muscles, and the deterioration of connective tissue. Attention needs to be paid to the development of umbilical hernias after laparoscopic trocar insertion. All trocar sites larger than 10 mm should be properly closed after operation. The high morbidity and mortality associated with incarcerated umbilical hernias demand an elective repair in all circumstances. There is a lack of control trials evaluating the results of surgical repairs based on the tight overlapping closure of the umbilical ring described by Mayo, while recurrence after umbilical herniorrhaphy is thought to be a common event. The possibility of the application of biomaterials to the surgical correction of umbilical hernias that have been successfully used in the inguinal canal opens a new field for further clinical investigation. Control studies with long follow-up are now required in order to establish evidence based umbilical surgery.
Surgical Endoscopy, 2003
Background: There is no consensus on the best technique for the repair of umbilical hernia in adults. The role of laparoscopic hernioplasty of umbilical hernia remains controversial. This study was undertaken to compare the outcomes of open and laparoscopic onlay patch repair of umbilical hernia in adults. Methods: From January 1996 to December 2002, 102 patients underwent elective repair of umbilical hernia. Operative techniques included Mayo repair (n = 43), laparoscopic onlay Gore-Tex patch hernioplasty (n = 26), suture herniorrhaphy (n = 24), and mesh hernioplasty (n = 9). Results: Demographic features and risk factors were similar among the four groups. The operative time of laparoscopic hernioplasty (median, 66 min) was significantly longer than those for patients who underwent Mayo repair (60 min) or sutured herniorrhaphy (50 min) (p < 0.05). None of the patients who underwent laparoscopic patch repairs required conversion to open repair. The median pain score at rest on postoperative day 1 was significantly lower in patients who underwent laparoscopic repair compared to those who had Mayo repair. A significantly shorter hospital stay and a lower wound morbidity rate were also observed in patients who underwent laparoscopic repair. With a mean follow-up of 2 years, suture herniorrhaphy had a relatively high recurrence rate (8.7%), whereas no recurrence was documented for the other techniques. Conclusions: Laparoscopic onlay patch hernioplasty is a safe and efficacious technique for the repair of umbilical hernia. Compared to Mayo repair, the laparoscopic approach confers the advantages of reduced postoperative pain, shorter hospital stay, and a diminished morbidity rate.
Umbilical Hernia Factors Affecting Outcome
Journal of Evolution of Medical and Dental Sciences, 2016
Aim of this study is to compare the effectiveness of surgical technique-Mesh repair techniques versus anatomical repair techniques with respect to the parameters of complications and recurrence rate. MATERIALS AND METHODS A detailed clinical study of paraumbilical hernia treated with both Mesh repair and Anatomical repair was undertaken at Department of General Surgery from January 2015 to June 2016 at K.R. Hospital attached to Mysore Medical College and Research Institute. Sixty patients were randomly assigned to Group A-Mesh Repair and Group B-Anatomical (Mayo's Repair). The same group of patients were studied for incidence, clinical features, treatment and postoperative complications pertaining to study period. Pts with irreducibility and incarcerated hernia were excluded from the study. Median period of followup was eighteen months. RESULTS Paraumbilical hernia is more common between 3rd and 6th decade of life. It is more common in males 56.7% than in females. There is no difference in age distribution of cases between males and females. Most common presenting symptom is swelling around the umbilicus, which may or may not be associated with pain. Most common position was Supraumbilical (56.7%), post-op complications like wound infection occurred in 10% in mesh repair and 6.67% in anatomical repair. In long-term follow-up, the recurrence was higher in Mayo's suture repair (10%) compared to mesh repair (3.33%) in our studies. CONCLUSION This study concludes that mesh repair has low recurrence rate with minimum complications. Mesh repair is considered the best and more superior to anatomical repair in due consideration to recurrence; however, in certain circumstances anatomical repair holds good which is cheaper and simple procedure.
British Journal of Surgery
Background Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. Methods The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019. Results Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommen...
Factors Associated With Long-term Outcomes of Umbilical Hernia Repair
JAMA surgery, 2017
Umbilical hernia repair is one of the most commonly performed general surgical procedures. However, there is little consensus about the factors that lead to umbilical hernia recurrence. To better understand the factors associated with long-term umbilical hernia recurrence. A retrospective cohort of 332 military veteran patients who underwent umbilical hernia repair was studied between January 1, 1998, and December 31, 2008, at the VA Boston Healthcare System. Recurrence and mortality outcomes were tracked from that period until June 1, 2014. Data were collected on patient characteristics, operative, and postoperative factors and univariate and multivariable analyses were used to assess which factors were significantly associated with umbilical hernia recurrence and mortality. All patients with primary umbilical hernia repair, with or without a concurrent unrelated procedure, were included in the study. Patients excluded were those who underwent umbilical hernia repair as a part of a...
A Comparitive Study of Open Vs Laparoscopic Repair in Umbilical and Para Umbilical Hernias
IOSR Journals , 2019
Background: The incidence of umbilical hernias has been reported to be as high as 2% in the adult population and comprises 10% of all hernia repairs performed annually.(1) Umbilical hernias in infants are congenital and are common. It is due to leukocyte adhesion molecule deficiency. They close spontaneously in most cases by the age of 2 years. Those that persist after the age of 5 years are frequently repaired surgically. Umbilical hernias in adults are largely acquired. These hernias are more common in women and in patients with conditions that result in increased intra-abdominal pressure, such as pregnancy, obesity, ascites, or chronic abdominal distension. Materials and methods: This study was a prospective observational study, conducted on 156 patients during a period of 19 months, including all the patients of umbilical and paraumbilical hernia operated in RANGARAYA MEDICAL COLLEGE , KAKINADA within the study period. Results: The laparoscopic umbilical / paraumbilical hernia repair is a better alternative to open hernia repair in view of less post-operative pain, surgical site complications, hospital stay and early return to normal activity, preservation of umbilicus, with better cosmetic value even though it requires longer operative time and recurrence rates are almost similar in both the procedures.
Structure of direct and indirect umbilical hernia and the implication on surgical repair in children
Annals of Pediatric Surgery, 2020
Background Umbilical hernia (UH) is one of the most common problems seen by paediatric surgeons. The recurrence rate after surgical repair is 1–2%. In this study, we examined the ring of umbilical hernia histologically to detect differences between the two types of umbilical hernia and the relation between this histologic difference and the technique of surgical repair. Results Fifty paediatric patients of both sexes with clinically diagnosed direct and indirect (oblique) umbilical hernia were collected from the paediatric surgery department in the period between March 2016 and February 2018. Age ranged between 2 and 5 years. Biopsies (5 mm) were taken from the upper, lower, right and left borders of the ring in both types and processed for histological examination. Classification of umbilical hernia was based on Chang-Seok et al.’s classification, which classified the umbilical hernia into three types (direct, oblique and hernia into umbilical cord) which depend on the presence of ...
Management in patients with liver cirrhosis and an umbilical hernia
Surgery, 2007
Optimal management in patients with umbilical hernias and liver cirrhosis with ascites is still under debate. The objective of this study was to compare the outcome in our series of operative versus conservative treatment of these patients. Methods. In the period between 1990 and 2004, 34 patients with an umbilical hernia combined with liver cirrhosis and ascites were identified from our hospital database. In 17 patients, treatment consisted of elective hernia repair, and 13 were managed conservatively. Four patients underwent hernia repair during liver transplantation. Results. Elective hernia repair was successful without complications and recurrence in 12 out of 17 patients. Complications occurred in 3 of these 17 patients, consisting of wound-related problems and recurrence in 4 out 17. Success rate of the initial conservative management was only 23%; hospital admittance for incarcerations occurred in 10 of 13 patients, of which 6 required hernia repair in an emergency setting. Two patients of the initially conservative managed group died from complications of the umbilical hernia. In the 4 patients that underwent hernia correction during liver transplantation, no complications occurred and 1 patient had a recurrence. Conclusions. Conservative management of umbilical hernias in patients with liver cirrhosis and ascites leads to a high rate of incarcerations with subsequent hernia repair in an emergency setting, whereas elective repair can be performed with less morbidity and is therefore advocated.
Is prosthetic umbilical hernia repair bound to replace primary herniorrhaphy in the adult patient?
Hernia, 2002
Given the outstanding outcome that prosthetic repair has recently achieved in the repair of inguinal hernia, we wonder whether it should be implemented as the gold-standard technique for umbilical hernia repair. We report on 213 adult patients who underwent surgery for umbilical hernia at our Day Surgery Unit from June 1992 to January 1998. Criteria for exclusion included problematic social and family environment and ASA IV status. A polypropylene plug was placed in small umbilical defects, whereas large defects (>3 cm in diameter) were repaired with a polypropylene mesh. The mean follow-up was 64 months. The mean age was 57.1 years, with females accounting for the majority (57.8%). Most patients (88.3%) were classified as ASA I-II. With regard to the hernia size, 143 patients (67.1%) presented with small defects (<3 cm). The anaesthetic technique of choice was local plus sedation. Reported complications included seroma (5.6%), haematoma (2.3%), wound infection (1.4%), and intolerance to prosthesis (0.95%), the last causing recurrence. The overall recurrence rate at a mean follow-up of 64 months was 0.95%. Prosthetic umbilical hernia repair can safely be performed in adults, and the rate of recurrence in this study is low in comparison to primary tissue repair.