Simultaneous Repair of Para-Umbilical Hernia during Cesarean Section (CS): A Novel Approach

Abstract

Background: Pregnant women that are complaining from paraumbilical hernia postpone its repair until they get birth. We hypothesized that it will be better to perform hernia repair of such type of hernia simultaneously during performing cesarean section (CS) which will help to decrease future morbidity re-operation, avoid complications and further skin incision. In this study we aimed to compare the value of performing para-umbilical hernia repair simultaneously during performing CS through the same skin incision with performing para-umbilical hernia repair simultaneously during performing CS through another infra- or supra-umbilical skin incision and performing para-umbilical hernia repair electively later on after healing of a CS skin incision in relation to clinical recovery and patient satisfaction. Patients and Methods: This is a prospective cohort study, where we included 45 pregnant female patients who will give birth by CS, and we have divided them into 3 groups: the first group of patients (A) included 15 patients that undergoing paraumbilical hernia repair by pre-peritoneal mesh insertion through CS incision, the second group of patients (B) in-cluded 15 patients that undergoing paraumbilical hernia repair by infra- or supra-umbilical incision during CS incision and the third group of patients (C) included 15 patients that undergoing paraumbilical hernia repair by infra- or supra-umbilical incision later on after healing of the CS wound. We have evaluated advantages of that novel approach e.g. operation time, severity of pain, peri-partum and post-operative complications, financial cost, duration of hospital stay, clinical recovery, mesh rejection, and patient satisfaction. Results: In group A there is shorter duration of hospital stay, no new skin incision (p < 0.001), low incidence of early complications like umbilical ischemia, wound infection, wound dehiscence, seroma, skin flaps ischemia (p = 0.027), low incidence of late complications like painful ugly scar and mesh rejection (p = 0.05). Group A showed the highest incidence of clinical recovery and patients’ satisfaction (p > 0.002). Conclusions: Performing para-umbilical hernia repair by insertion of a pre-peritoneal mesh simultaneously during performing CS through the same skin incision is the best method of management of para-umbilical hernia in pregnant woman.