Fixation free prosthetic repair of large umbilical hernia granting a broad defect overlap

Abstract

lntroduction: Umbilical hernia is a common surgical disease, accounting for l0-147o of all hernias and having many therapeutic options. Pure tissue repair is affected by a recurrence tp to 40Vo. Prosthetic mesh repair is now widely utilized with a decrease of recurrences up to 107o. Nevertheless, if large defect are present, assuring a wide overlap and a fixation-free technique still represent an issue. In this report we describe the outcomes of an umbilical hernia repair technique via a new implant with radiating straps at its boundary. Material and methods: A light weight, large porous polypropylene implant having a central body of 12x15 cm in diameter and eight radiating straps was used to repair umbilical hernia in 31 patients with defect size >2 cm. The implant was placed via open technique in preperitoneal or retra muscular sublay position. To secure the mesh in place, the straps were tunneled laterally through the rectus muscles by using a spe- cially designed passing needle. No fixation of the implant was nec- essary. Median follow-up was 2,8 years (range 3,6-2 years). Results: With this new method and prosthetic implant we achieved a simplified and faster surgical procedure. There were no intra-oper- ative complications to report. In the follow up, we recorded 2 sero- mas. No hematoma, chronic pain, strap pain or recurrences have been reported to date. Conclusions: The integrated straps seemed to allow a very wide lat- eral mesh placement, assuring suff,cient defect overlap; important if mesh shrinkage occurs. The inherent elongation of the straps helps to absorb forces exerted upon the implant during early recovery, thus avoiding mesh dislodgement in this critical phase before tissue ingrowth has occurred. These advantages are clearly demonstrated and result in: fixation-free mesh placement, simplified procedure- broader coverage of the abdominal wall, shortening of the operative time and decreased postoperative complications.