Shall we use a mesh in every patient undergoing repair surgery for umbilical hernia? a prospective study

Yıl 2019, Cilt: 44 Sayı: 1, 169 - 175, 31.03.2019

Hakan Özkan Acar Aren , Aylin Hande Gökçe

https://doi.org/10.17826/cumj.450848

Cited By: 1

Öz

Purpose: The aim of this study is to compare the outcomes in patients with umbilical hernia who underwent suture-only repair (primary suture repair and Mayo’s repair) to those with mesh (hernia repair with prolene or the Ventralex Hernia Patch (VHP) hernia repair).

Materials and Methods: ASA 1 and ASA 2 patients who had no medical condition requiring surgical intervention other than umbilical hernia were included in this study.. Small hernias were repaired by suturing only while mesh repair was used for medium size and large hernias. Among parameters to be assessed were presence of comorbidities, hernia repair techniques, postoperative complications, and postoperative recurrence rates by repair techniques. Follow-up assessments including physical examinations and/or ultrasound studies were performed to evaluate potential recurrences and other complications. 

Results: A total of 153 patients were included in the study. The incidence of seroma formation was significantly higher in the prolene mesh group than others. Recurrences occurred in four out of 25 patients who underwent primary repair (16%) and three out of 69 patients who underwent Mayo’s repair (4.3%). Recurrence rates were statistically significantly higher in the primary suture repair group than the other groups. 

Conclusion: In this study, overall recurrence rate following umbilical hernia repair was found to be 4.57%.  Recurrences were not observed in mesh group. Low complication and recurrence rates suggest that this technique may be an appropriate surgical modality to repair umbilical hernias 2 cm or less in size. Umbilical hernia repair with mesh appears to be superior over than tissue-suture repair without mesh. 

Anahtar Kelimeler

Umbilical hernia, primary repair, Mayo’s repair, prolene mesh, Ventralex Hernia Patch, postoperative complications

Umblikal herni onarımında her hastaya mesh koyalım mı? prospektif klinik çalışma

Öz

Amaç: Çalışmamızda sütür (primer ve Mayo tekniği ile onarım) ve mesh ile (prolen ve ventralex hernia patch (VHP) ile herni onarımı) ameliyat edilen hastaların sonuçlarını karşılaştırmayı amaçladık. 

Gereç ve Yöntem: Çalışmaya ASA 1 ve 2 kategorisinde ve umblikal herni yanında ek ameliyat girişimi yapılacak patolojisi olmayan hastalar alındı. Küçük herniler suture tekniği, orta ve büyük herniler mesh ile onarıldı. Hastalar cinsiyet, yaş, vücut kitle indeksi, ek hastalık varlığı, herni onarım teknikleri, postoperative komplikasyonlar, postoperative tekniğe göre nüks oranları açısından değerlendirildi. Hastalar ameliyat sonrası 1. Hafta ve 6. Ay nüks ve diğer komplikasyonlar açısından muayene ve/veya ultrasonografi ile kontrol edildi.

Bulgular: Çalışmaya toplam 153 hasta alındı. Primer onarım, Prolen mesh grubunda seroma oranı diğer üç gruptan belirgin yüksek bulundu. Primer onarım uygulanan 25 hastadan 4' ünde (16%), Mayo takviye yapılan 69 hastadan 3' ünde (4.3%) nüks görüldü. Primer onarım yapılan grupta nüks oranı diğer gruplardan istatistiksel olarak belirgin yüksek bulundu.  

Sonuç: Çalışmamızda umbilical herni onarımı sonrası nüks oranı %4.57 olarak bulundu. Prolen ve VHP mesh ile umblikal herni onarımı sonrası çalışmamızda nüks saptamadık. Komplikasyon ve nüks oranı düşüklüğü bu tekniği 2 cm ve altındaki umbilical herni ameliyatları için iyi bir yöntem olarak düşündürmektedir. Umbilikal fıtık onarımlarında; mesh ile onarım, non-mesh/doku-dikiş onarımından daha üstün gözükmektedir. 

Anahtar Kelimeler

Umblikal herni; primer onarım, Mayo tekniği, prolen mesh, ventralex hernia patch, postoperatif komplik asyon

Kaynakça

• 1. Cassie S, Okrainec A, Saleh F, Quereshy FS, Jackson TD. Laparoscopic versus open elective repair of primary umbilical hernias: short-term outcomes from the American College of Surgeons National Surgery Quality Improvement Program. Surg Endosc. 2014;28(3):741-746.
• 2. Dabbas N, Adams K, Pearson K, Royle G. Frequency of abdominal wall hernias: is classical teaching out of date? JRSM Short Rep 2011;19; 2(1): 5.
• 3. Martin DF, Williams RF. Ventralex mesh in umbilical/epigastric hernia repairs: clinical outcomes and complications. Hernia 2008;12(4):379-83.
• 4. Kamer E, Unalp HR, Derici H, Tansug T, Onal MA. Laparoscopic cholecystectomy accompanied by simultaneous umbilical hernia repair: a retrospective study. J Postgrad Med. 2007;53(3):176-80.
• 5. Venclauskas L, Jokubauskas M, Zilinskas J, Zviniene K ,Kiudelis M. Long-term follow-up results of umbilical hernia repair. Videosurgery Miniinv 2017;12(4):350–356.
• 6. Arunagiri V, Padmanabhan R, Mayandi P. A short term analysis of surgical management of umbilical and paraumbilical hernia. Turk J Surg 2018;34(1):21-23..
• 7. Sanjay P, Reid TD, Davies EL, Arumugam PJ, Woodward A. Retrospective comparison of mesh and sutured repair for adult umbilical hernias. Hernia 2005;9(3):248-51.
• 8. Hadi HI, Maw A, Sarmah S, Kumar P. Intraperitoneal tension-free repair of small midline ventral abdominal wall hernias with a Ventralex hernia patch: initial experience in 51 patients. Hernia 2006;10(5):409-13.
• 9. . Lau H, Patil NG. Umbilical hernia in adults. Surg Endosc. 2003;17(12):2016-20.
• 10. Celdran A, Bazire P, Garcia-Urena MA, Marjuan JL. H-hernioplasty: a tension free repair for umbilical hernia.Br J Surg 1995;82(3): 371-2.
• 11. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, et al. Classification of primary and incisional abdominal wall hernias. Hernia 2009;13(4):407-14.
• 12. Sinha SN, Keith T. Mesh plug repair for paraumbilical hernia. Surgeon 2004 ;2(2):99-102.
• 13. Kulaçoğlu H. Current options in umbilical hernia repair in adult patients. Ulus Cerrahi Derg 2015;31(3):157-161.
• 14. Bencini L, Sanchez LJ, Bernini M, Miranda E, Farsi M, Boffi B, et al. Predictors of recurrence after laparoscopic ventral hernia repair. Surg Laparosc Endosc Percutan Tech 2009;19(2):128-132.