Study of etiological factors and analysis of various surgical repair techniques for paraumblical hernia

AIM OF THE STUDY: 1. To analyze the etiological factors of paraumblical hernias in adults. 2. To find the possibility of hypothyroidism, being a risk factor for paraumbilical hernias. 3. To compare the outcomes of primary suture repair with mesh repair of paraumbilical hernias. 4. To analyze the post-operative course of paraumblical hernia repair. MATERIALS AND METHODOLOGY 1. Study Centre- Madras Medical College and Rajiv Gandhi Government General hospital. 2. Duration: February 2017 - September 2017. 3. Study Design: Observational study (Prospective). 4. Sample Size: 50 patients. Inclusion Criteria: 1. All patients diagnosed with paraumbilical hernia and its related complications for surgical management were included in the study. 2. Age >18 years. 3. All patients who gave consent for the study. Exclusion Criteria: 1. All incisional hernias occurring around the umbilicus. 2. Umbilical hernioplasty performed incidentally during other laparotomy procedures. 3. Recurrent paraumbilical hernias. RECOMMENDATIONS: 1. A large multicenter trial is essential to have a larger sample to make the data more informative. 2. A long term standardised follow up study for at least 5 years could be more authentic to find out late recurrences. 3. Randomisation of recruits into mesh and anatomical group will definitely improve the outcome of the study. CONCLUSION: As the age advances medical co-morbidities may be associated more, including diabetes mellitus. Swelling and pain were the common presenting complaints. Half of the cases were obese with equal prevalence both in men and women. More than half of the hernias were larger than 3 cm and omentum being the most common content of the sac. Presence of obstructive symptoms in hernia larger than 3cm may be an indication of irreducibility. Mesh repair and drain has been the preferred method in elective cases. This resulted in the lower incidence of seroma, hematoma and wound infection. Immediate postoperative complications were strongly associated with 1. Emergency surgery, 2. Hernia size >3cm and 3. Irreducibility. Use of mesh will definitely reduce the recurrence rate in adult umbilical hernia