Methods for umblical hernia repair when combined with laparoscopic cholecystectomy
Salih Tosun, Oktay Yener, Ozgur Ekinci, M Ali Aydemir
Introduction: Umblical hernia repair can be combined with laparoscopic cholecystectomy (LC) session which provides opportunity to get single anesthesia exposure, single hospital stay with minimum loss of working days. Aim: We have aimed to determine the optimal repair method for small umbilical hernias during LC and investigated the safety and the efficiency of these combined operations. Methods: We have analyzed the LC cases in our surgical department who underwent LC and primary umblical hernia repair together retrospectively in three years period. Patients’ demographic data, operation time, mesh application time, hospital stay, complications, surgical technique were analyzed in the database. Patients were assigned to two groups. If the patients BMI was less than 30 kg/m2, primary suturing was performed seperately using 1/0 prolene. If the patients BMI was greater than 30 kg/m2, a 5cm diameter flat, self gripping prolene patch mesh was inserted. After 24 months, patients were reexamined for recurrency with clinical examination. If there was doubt, ultrasonography was applied for detection of the recurrency. Results: During 3 years period 1762 LCs were performed. 120 of these cases underwent combined surgery.(6.8%). There were 77 male and 43 female patient. Group 1 consist of 92 patients and Group 2 consist of 28 patients. The mean hospital stay was 2 days (range 1-4 days) for both groups (2±1.1 days for Group1 and 2± 1.4 days for Group2). The mean operation time was 56 min (range 32-125 min). After taking the specimen, the time of surgery for hernia repair was approximately 8 minutes (6-22) in Group 1, whereas it was about 10 minutes (6-30) in Group 2. During the follow up after 2 years period, in Group 1; 78 patients were eligible and there were 4 (5.1%) recurrencies in this group. In Group 2; 26 patients were eligible and there was 1 case of recurrency (3.8%). Conclusion: Watchful waiting can be considered safe for patients with small asymptomatic umbilical hernias. If LC is planned for conditions like symptomatic cholelithiasis,combined umblical hernia repair in the same operation provides extra benefit. Patients demographics especially like BMI is an important factor deciding the repair method of the small umblical hernias. If BMI is low, sutured repair can be choosen over mesh repair or vice versa. Tailored surgery is needed even in small asymptomatic umblical hernias in combined procedures.