title: Tension-free mesh repair of umbilical hernia as a day case using local anaesthesia.
abstract: BACKGROUND
  Umbilical hernias are a common surgical problem with a high recurrence rate using conventional suture techniques. This prospective study examined the feasibility of tension-free mesh repair as a day case using local anaesthetic (LA) for all primary umbilical hernias.
  
  
  METHODS
  Fifty-four patients (eight women) were operated on; 49 using LA. Through a periumbilical skin incision the margins of the sac were freed from the edges of the defect, and a space was made in the extraperitoneal plane. In defects <3 cm in diameter, a cone of polypropylene (pp) mesh was inserted and attached with nonabsorbable sutures. In defects >3 cm, a flat piece of pp mesh was inserted into the extraperitoneal space as a sublay. No attempt was made to close the fascial defect.
  
  
  RESULTS
  Postoperative pain was graded as mild ( n=37) and moderate ( n=17). No patient had severe postoperative pain. Seven superficial wound infections responded to oral antibiotics. In no case it was necessary to remove the mesh. There were no other complications. Patients were recalled between 2 and 6 years postopertively-mean follow-up 43 months (28- 67). There were no recurrences.
  
  
  CONCLUSIONS
  Umbilical hernia repair can be carried out safely and securely under LA with a tension-free mesh technique (cone or a sublay patch) with a low morbidity, negligible recurrence rate, and a high degree of patient satisfaction. It should be the procedure of choice for all such hernias.
authors.affiliation: British Hernia Centre, 87 Watford Way, NW4 4RS, London, UK. surgeons@hernia.org
authors.forename: M
authors.initials: M
authors.lastname: Kurzer
authors.forename: P A
authors.initials: PA
authors.lastname: Belsham
authors.forename: A E
authors.initials: AE
authors.lastname: Kark
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000772:Anesthesia, Local; D005240:Feasibility Studies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D012008:Recurrence; D013526:Surgical Mesh; D013530:Surgical Wound Infection