A Comparative study of umbilical hernia repair by open and laparoscopic method

Suseela, G (2010) A Comparative study of umbilical hernia repair by open and laparoscopic method. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: Embryologically, the fascial margins of the umbilical defect are formed by the third week of foetal life when the four folds of the somatopleurae tend to fold inward. An umbilical cord is produced in the fifth week. By the tenth week of embryonic life, abdominal contents return from their location out side the coelom into the developing abdominal cavity. The vitelline duct and the allantois regress by the fifteenth to sixteenth week. If any of these processes are defective, umbilical malformations occur. At birth, the umbilical arteries and the umbilical vein are thrombosed, and the vitelline duct and the allantois have already been obliterated. The umbilical ring then scars and contracts. The obliterated umbilical vein (round ligament) is usually attached to the inferior border of the umbilical ring along with remnants of the urachus and the two obliterated umbilical arteries. The round ligament, by crossing and partially covering the umbilical ring, may protect against herniation. In instances where the ligament divides and inserts in the upper part of the umbilical ring without crossing it, a potential weakness is present. The umbilical Richet’s fascia also reinforces the umbilicalring. If Richet’s fascia is absent, located outside the limits of the umbilical ring, (or) only partially covers the ring, the area appears much weaker. AIM OF THE STUDY: To study the outcome of: 1. Open repair and Laproscopic repair for umbilical hernias – a comparitive study. 2. Primary closure versus mesh repair. MATERIALS AND METHODS: This is a prospective type of comparative study conducted from December 2007 to November 2009 at Government Rajaji Hospital, Madurai includes 50 patients who underwent open anatomical and meshrepair and laproscopic anatomical and mesh repair methods of umbilical Hernia repair. The patients included in this study were randomly selected from those who underwent open anatomical and mesh repair and laproscopic anatomical and mesh repair including elective and emergency procedures for complications. The relevant data of patients included in the study were collected recorded as follows, Name, age, sex, occupation, Nutritional Status, present history, size of defect, complications, collected were observed for and recorded in the proforma. Post operative period and complications were noted. CONCLUSION: Laparoscopic mesh repair produce low recurrence rate with less morbidity. The evidence available at present suggests that laparoscopic repair is feasible, safe although experience with the new meshes is still limited and less cost effective. With the existing data, it will be prudent to recommend laparoscopic repair as the first line treatment for umbilical hernia where the facilities and expertise are available, where it is not, open mesh repair remains a suitable alternative. As laparoscoic skills improve, it is likely that laparoscopic repair will be more widely performed in future.

Item Type: Thesis (Masters)
Uncontrolled Keywords: umbilical hernia repair ; open and laparoscopic method ; comparative study.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 02 Jun 2018 15:23
Last Modified: 02 Jun 2018 15:34
URI: http://repository-tnmgrmu.ac.in/id/eprint/8099

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