title: Mesh/Meshless paraumbilical hernia repair with concomitant single-incision transumbilical three-port laparoscopic cholecystectomy-prospective observational study of 126 patients.
abstract: BACKGROUND
  Paraumbilical hernia with benign gallbladder disease forms a challenging combination for offering benefits of single-incision surgery. The purpose of this prospective observational study was to assess the outcomes of paraumbilical hernia repair performed concomitantly with three-port laparoscopic cholecystectomy through the same periumbilical incision using routine instruments.
  
  
  METHODS
  In total, 126 subjects formed the patient cohort. The mean age for females was 38.5 years, and that for the males was 40 years. The periumbilical curved incision accommodated three independent ports for conducting the cholecystectomy. The subsequent choice for the hernia repair was subject to the size (diameter) of the defect. Defects <4 cm in diameter (n=96) were suture-closed without mesh reinforcement. For defects 5-8-cm in diameter (n=33), an innovative technique of inserting all three ports directly into the peritoneal/hernial sac in a triangular manner was used for the cholecystectomy. Such a hernia defect was then reinforced with preperitoneal polypropylene mesh before closing it primarily after releasing the posterior rectus sheath. However, defects >8 cm were excluded from the study.
  
  
  RESULTS
  The mean operative time was 75 minutes. Patients were discharged after a mean of 1.5 days. Four patients were converted to conventional laparoscopic cholecystectomy owing to technical difficulty. An umbilical seroma occurred in 3 patients. Over the mean follow-up of 38.5 months, none of the patients had paraumbilical hernia recurrence. A hernial sac was used to space out the ports. The morbidity of the procedure was acceptable.
  
  
  CONCLUSIONS
  Concomitant paraumbilical repair and cholecystectomy by the technique described is effective and safe for select patients. Prosthetic reinforcement is advisable for hernia defects with a diameter of 5-8 cm.
authors.affiliation: 1 Department of General & Minimal Access Surgery, Mahatma Gandhi Institute of Medical Sciences , Sevagram, Wardha, Maharashtra, India .
authors.forename: Priyadarshan Anand
authors.initials: PA
authors.lastname: Jategaonkar
authors.forename: Sudeep Pradeep
authors.initials: SP
authors.lastname: Yadav
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods*; D015331:Cohort Studies; D061887:Conversion to Open Surgery; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000150:complications* / Q000601:surgery*; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D061646:Operative Time; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*