title: Minimal incision scar-less open umbilical hernia repair in adults - technical aspects and short-term results.
abstract: BACKGROUND
  There is no gold standard technique for umbilical hernia (UH) repair. Conventional open UH repair often produces an undesirable scar. Laparoscopic UH repair requires multiple incisions beyond the umbilicus, specialized equipments, and expensive tissue separating mesh. We describe our technique of open UH repair utilizing a small incision. The technique was derived from our experience with single incision laparoscopy. We report the technical details and short-term results.
  
  
  METHODS
  This is a retrospective analysis of the first 20 patients, who underwent minimal incision scar-less open UH repair, from June 2011 to February 2014. A single intra-umbilical curved incision was used to gain access to the hernia sac. Primary suture repair was performed for defects up to 2 cm. Larger defects were repaired using an onlay mesh. In patients with a BMI of 30 kg/m(2) or greater, onlay mesh hernioplasty was performed irrespective of the defect size.
  
  
  RESULTS
  A total of 20 patients, 12 males and 8 females underwent the procedure. Mean age was 50 (range 29-82) years. Mean BMI was 26.27 (range 20.0-33.1) kg/m(2). Average size of the incision was 1.96 range (1.5-2.5) cm. Mesh hernioplasty was done in nine patients. Eleven patients underwent primary suture repair alone. There were no postoperative complications associated with this technique. Average postoperative length of hospital stay was 3.9 (range 2-10) days. Mean follow-up was 29.94 months (2 weeks to 2.78 years). On follow-up there was no externally visible scar in any of the patients. There were no recurrences on final follow-up.
  
  
  CONCLUSIONS
  This technique provides a similar cosmetic effect as obtained from single port laparoscopy. It is easy to perform, safe, offers good cosmesis, does not require incisions beyond the umbilicus, and cost effective, with encouraging results on short-term follow-up. Further research is needed to assess the true potential of the technique and the long-term results.
authors.affiliation: Department of General, Laparoscopic and Gastrointestinal Surgery, Malankara Orthodox Syrian Church Medical College , Cochin , India.
authors.forename: Sanoop K
authors.initials: SK
authors.lastname: Zachariah
authors.affiliation: Department of General, Laparoscopic and Gastrointestinal Surgery, Malankara Orthodox Syrian Church Medical College , Cochin , India.
authors.forename: Najeeb Mohamed
authors.initials: NM
authors.lastname: Kolathur
authors.affiliation: Department of General, Laparoscopic and Gastrointestinal Surgery, Malankara Orthodox Syrian Church Medical College , Cochin , India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Balakrishnan
authors.affiliation: Department of General, Laparoscopic and Gastrointestinal Surgery, Malankara Orthodox Syrian Church Medical College , Cochin , India.
authors.forename: Arun Joseph
authors.initials: AJ
authors.lastname: Parakkadath
keywords: hernia; hernioplasty; scar-less surgery; umbilical hernia; ventral hernia; visceral surgery