Mesh plug repair for paraumbilical hernia

ABSTRACT

The standard method of repair of paraumbilical hernia [PUH] is by Mayo's technique, using a double breasted flap of the rectus sheath. The present study describes and evaluates the application of 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 hernia. Twenty patients with paraumbilical hernia [PUH] admitted to Assiut University Hospital, General Surgery Departments between April 2004 and April 2006. There were twelve [12] female [60%] and eight [8] male [40%] with median age group 53 years [range 34-86 years]. Whenever local anaesthic was used. This technique included 3-4cm incision either supra or infraumbilically, the sac was dissected from the surrounding tissues till the margin of the hernial ring, the content of the sac reduced followed by reduction of the sac in the abdomen. Cigarettes stub was done from prolene mesh sheet [2.5cm x10cm]. The stub inserted into the defect with its external margin flush with the hernial ring and fixed to it with prolene 3/0 suture. Then suction was inserted subcutaneously and the wound closed with subcuticular suture. Follow up was done for 18 month. Patients with local anaesthesia discharged from the hospital within 24 hours and those with general anaesthesia discharged within 48 hours without anaesthetic complications and post-operative pain controlled with non narcotic analgesia. The post-operative complications were two cases [10%] of wound infection. The patients return to normal activity after 7 days [range from 4-12 days]. Seventeen patients [85%] satisfied the procedure and recurrence occurred in one case only [5%]. Mesh plug repair can be performed with minimal post-operative complications, low recurrence rate, minimal post-operative pain and achieving excellent patient satisfaction. Prosthetic mesh plug repair under local anaesthetic could become the standered treatment for PUH in adults