A study on clinical presentation of umbilical and paraumbilical hernia in adults

Abstract

Aim & Objectives: To study clinical presentation of umbilical and paraumbilical hernia in adult i.e distribution with respect to age and sex and mode of presentation. Methodology: External abdominal hernia surgeries; constituted 32.39% of total major OT cases at GIMS &District Hospital Kalaburagi from Aug 2015 to July 2018. Results: Umbilical hernia constituted 8.6% of external abdominal hernia. Paraumbilical hernia formed 66.6% of umbilical hernia with supra umbilical being more common. Out of 30 patients, 17 patients were between age group 31 to 50 years. 20 patients were females, ratio being male: female 1:2. Swelling around the umbilicus was the main common presentation with pain in the swelling in half of the cases. Minimum duration of complaints at the time of presentation was 6 days, and maximum duration was 7 years. Majority of umbilical hernia patients i.e 80% patients presented with irreducibility. I patient had skin ulceration, 3 patients had intertrigo, I patient had inflamed hernia and I patient had obstructed paraumbilical hernia. Obesity and multiparity were most common associated risk factor. 7 patients had chronic cough due to COPD and one patient had Wo ascites, which was well controlled at the time of presentation. Mayos repair was most common operation performed for umbilical hernia repair, done in 23 patients. simple transverse repair was done in 5 patients umbilicus was preserved in 4 cases, with small hermal sacs. In one patient mesh repair was done. In I patient with obstructed paraumbilical hernia, emergency surgery with simple transverse repair was done. In all cases prolene No. 1 was used for repair. In maioritv of the cases defect was more than 1.5 cms. 5 patients had 2 defects in the limb of skin Incision lines. 30 patients with umbilical hernia contained small bowel for omentum or both . In cases general anaesthesia was used and tn5 cases spinal anaesthesia was given. Peri operative antibiotics were used in all cases. In 25 cases redivac suction drains were used. In 5 patients who needed little dissection, no drain was kept. Wound infection was the most common post operative complications, occurred in 13.3% of cases. Seroma occurred in I patient, and hematoma occurred in I patient- 19 patients stayed in the hospital for less than 8 days, 5 patients for 9 to 14 days and 6 patients for 15 to 21 days respectively. Conclusion: Surgery is the treatment of choice in all cases. The classic repair is that proposed by Mayo. In healthy individuals surgical repair with better non absorbable suture material given good results with a low recurrence rate.