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Bailey & Love's Surgery, 27th Edition Surgery Essence by Pritesh Singh (PGMEE) Sabiston's Textbook of Surgery
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Points to consider before Paraumbilical (Umbilical) Hernia Repair in an Obese Patient

Umblical Hernia in an Obese Patient
Umbilical Hernia in an Obese Patient

Umblical Hernia in a Obese Patient
Umbilical hernia showing as a soft tissue opacity on an erect abdomen X-ray film
Obese patients with umbilical hernia comprise a special group. Apart from anaesthetic considerations for an obese patient, following are few technical points to consider before taking an obese patient for surgery.


Obesity with BMI > 30 kg/m2 is one of the factor for surgical failure[1]

The patient’s BMI >30 kg/m2 and defects >2 cm have been reported as possible factors for surgical failure in a study by Venclauskas et al. Ninety-seven patients (Males:31 and Females:66) with umbilical hernia were examined in this study.  The recurrence rate was higher when hernia size was >2 cm (9% for <2 cm vs 10.5% for >2 cm) and patient's BMI was >30 kg/m(2) (8.6% for < 30 vs 10.7% for >30). 

Thus it is wise to counsel the patient for weight loss before an elective umbilical hernia surgery.

Laparoscopic umbilical hernia repair is better than open repair in Obese patients [2]

A comparative study by Colon et al. (2013) stated that laparoscopic umbilical hernia repair should be the preferred approach in obese patients. They found a significant increase in wound infection rate in the open mesh repair group when compared with the laparoscopic procedure (26% vs. 4%; p<0.05). They observed no hernia recurrence in the laparoscopic group, whereas the open group had 4% recurrence rate.


References

[1] https://www.ncbi.nlm.nih.gov/pubmed/19124962/

[2] https://www.sciencedirect.com/science/article/pii/S0002961012004369



Keywords: Umbilical Hernia and Obesity, Umbilical Hernia, Mesh, Suture, Mesh Repair, Suture Repair, Obesity, BMI

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