Enhancing safety in ventral patch repair for umbilical hernia by utilizing a hybrid technique

Abstract

BACKGROUND: Both suture and mesh repairs are used for smaller (1-3 cm) umbilical hernias. But primary repair has a higher recurrence rate in literature. The use of mesh repairs has become the way to go for small and medium sized ventral hernias. Ventral patch placement is a simple and effective procedure for the repair of umbilical hernias of 1–3 cm size. We demonstrate the safety and efficacy of the ventral patch for the same with our modification of the technique in 100 consecutive patients. We would initially insert the patch as described by the company, but had one patient presenting with intestinal obstruction, who on diagnostic laparoscopy had a small bowel loop entrapped between the patch and the anterior abdominal wall. This brought about a change in the original technique at our institute, which we adopted for all patients thereafter. MATERIALS AND METHODS: A single centre retrospective analysis of prospectively collected data was done. Our modified technique was done in 100 consecutive patients with umbilical hernia defect size ranging from 1 cm to 2.5 cm, from January 2017 to January 2021. Demographics, post-operative pain, duration of hospital stay, surgical site occurrences (early and late), post-operative complications and recurrences were noted. RESULTS: A total of 100 patients were included in the study. Two patients had superficial surgical site infection which was managed conservatively. We did not record any other major complications or recurrence. Visual analogue scale for pain was recorded at 24 hours. Majority (95%) of the patients had none to mild pain and were discharged at 24 hours. Five patients experienced moderate pain and were discharged at 36–48 hours. No patient experienced chronic pain at follow up. CONCLUSION: The hybrid technique of the ventral patch placement is a safe way for optimum visualization for the correct mesh placement and may improve results, decrease complications and recurrences.