Which repair in umbilical hernia of adults: primary or mesh?

In classic literature, knowing that small defects can be repaired primarily in umbilical hernias of adults, mesh repair should be reserved for larger defects. Conventional repair methods have resulted in high rates of recurrence. Therefore, this prospective study investigated the repair techniques in umbilical hernias of adults. The patients who underwent primary umbilical hernia operation between 1998 and 2003 were reviewed. Primary repair was conducted in defects less than 3 cm, whereas larger defects were repaired with polypropylene mesh. Postoperative complications, the length of hospital stay, and recurrence in follow-up were recorded. Of 111 patients, primary repair was carried out on 63 patients, and 48 underwent polypropylene mesh repair. Recurrence rate was significantly higher in the primary repair group (14%) compared with polypropylene mesh repair group (2%). In conclusion, contrary to the general tendency that small defects can be repaired primarily, polypropylene mesh should be used in all umbilical hernias regardless of the size of the defect.

Limberg flap repair for pilonidal sinus disease.

PURPOSE: There are many methods described for the treatment of sacrococcygeal pilonidal sinus disease, and none of them has been accepted as an optimal modality. Plastic procedures have some advantages, such as short duration of hospitalization, quick healing time, low risk of wound infection, and lower recurrence rates. Our choice is Limberg flap repair; we present here our experience with this procedure. METHODS: From August 1998 to July 2000, 147 male patients were treated with Limberg flap repair under regional anesthesia in a soldier's hospital. RESULTS: No major anesthetic complication or wound infection developed. Three patients (2 percent) had a seroma (with negative culture) and six patients (4.1 percent) had partial wound detachment. Patients returned to full activity on the 10th to 25th postoperative day (mean, 18.8). Patients were followed from 1 to 40 (mean; 13.1) months. Seven patients (4.8 percent) had a recurrence. CONCLUSION: The Limberg flap procedure is an easy and effective technique. Patient comfort, quick healing time, early return to full activity, and low complication and recurrence rates are the important advantages of this procedure.