Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated para-umbilical hernia: a prospective randomized study.
BACKGROUND
Although prosthetic repair has become the gold standard for elective management of para-umbilical hernia (PUH) its use in the setting of acute incarceration is still limited for fear of prosthetic-related complications, mainly infection. The objective of this study was to compare results from prosthetic repair and tissue repair in the management of the acutely incarcerated PUH.


METHODS
Forty-two patients were prospectively randomized to either the prosthetic-repair group (group 1 = 21 patients) or the tissue-repair group (group 2 = 21 patients). In group 1, an onlay polypropylene mesh was inserted and the presence of non-viable intestine was not considered a contraindication for mesh repair. Operative time, postoperative hospital stay, and postoperative complications were recorded. Follow-up was performed by physical examination to detect recurrence.


RESULTS
Mean operative time was significantly longer for group 1 (96.9 +/- 14.6 compared with 65.5 +/- 14.6 min for group 2, P < 0.05). Postoperative hospital stay did not differ significantly between the groups (3 +/- 1.6 compared with 3.5 +/- 2.2 days for groups 1 and 2, respectively). Postoperative complications did not differ significantly between the groups (28.6 vs. 23.8% for groups 1 and 2, respectively). No mesh had to be removed. At follow-up (mean 16 +/- 5.5 months) there were four recurrences in group 2 (4/21, 19%) and no recurrences in group 1 (P < 0.05).


CONCLUSIONS
Use of prosthetic repair for emergency management of incarcerated PUH is safe and leads to superior results, in terms of recurrence, compared with conventional tissue repair. The presence of non-viable intestine cannot, furthermore, be regarded as a contraindication for prosthetic repair.
Abdel-Baki
N A
NA
Department of General Surgery, Faculty of Medicine, University of Alexandria, Al-Azarita, Alexandria, Egypt.
Bessa
S S
SS
Abdel-Razek
A H
AH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006554:Hernia, Umbilical / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes / Q000627:therapeutic use*; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000601:surgery; D013524:Surgical Flaps; D013526:Surgical Mesh; D016896:Treatment Outcome
D011126:Polypropylenes