A Prospective Comparative Clinical Study on Repair of Paraumbilical Hernias with Mayo’s and Mesh Techniques and their Postoperative Complications

Abstract

Background: “Paraumbilical hernia” occurs through Linea Alba either above or below umbilicus. The current trend is to use a mesh for the repair irrespective of the size. The conventional suture method of Mayo’s is also being practiced in various centers. An attempt is made in this study to compare both the methods especially in relation to their post-operative complications in the long-term follow-up.
Aim of the Study: The aim of the study to study and compare Mayo’s method and use of mesh technique in the surgical management of repair of paraumbilical hernias in relation to their post-operative complications.
Materials and Methods: A cross-sectional prospective clinical study was conducted in the Department of General Surgery of Malabar Medical College Hospital, Modakkallur. Atholi, Kozhikode, Kerala, wherein 58 patients undergoing surgery for paraumbilical hernia were included in the study. The patients were assigned to these groups using random numbers from www.randomizer.org. The patients belonging to Group A were subjected to Mayo’s operation and Group B were subjected to Mesh technique. All the patients were asked thorough history taking followed by investigations of surgical profile before undertaking the surgery. All the patients were followed up from day 1 postoperatively for 2 years.
Observations and Results: A total of 58 patients with paraumbilical hernia were divided into 2 equal groups comprising of 29 each. The mean age in Group A was 43.65 ± 4.10 years and in Group B was 44.60 ± 3.20 years. There were 18 females and 11 males in Group A and 17 females and 12 males in Group B. The patients belonging to the age group of 33–62 years were 21/29 (72.41%) in group A and 23/29 (79.31%) in Group B. There was no statistical significance in the incidence among the two groups as P = 0.153 (P taken significantly at <0.05). The male to female ratio in Group A was 1:1.63 and 1:1.41 in Group B. Pain was complained in the post-operative period in 19/29 (65.51%) patients in Group A and 16/29 (55.17%) patients in Group B. Hematoma was observed in 5/29 (17.24%) patients in Group A and 7/29 (24.13%) patients in Group B. Seroma was observed in 4/29 (13.79%) patients in Group A and 3/29 (10.34%) patients in Group B.
Conclusions: In a follow-up of 2 months to years, among the procedures used classical Mayo’s repair had 4/29 recurrences and 1/29 were noted in patients underwent mesh repair. Even though Mayo’s repair for paraumbilical has been the procedure of choice in many centers, but the tension-free mesh repair has an advantage of having no recurrences and can be used in the presence of bigger defect and weaker abdominal muscle tone, thus showing a superior and favorable procedure than Mayo’s repair.