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Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated para-umbilical hernia.


Article Information

Title: Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated para-umbilical hernia.

Authors: Shabab Hussain, Khan Karim Afridi, Viqar Aslam, Mohammad Nasir, Fazal Ahmad

Journal: The Professional Medical Journal (TPMJ)

HEC Recognition History
Category From To
Y 2024-10-01 2025-12-31
Y 2023-07-01 2024-09-30
Y 2022-07-01 2023-06-30
Y 2021-07-01 2022-06-30

Publisher: Independent Medical College, Faisalabad- Pakistan

Country: Pakistan

Year: 2023

Volume: 30

Issue: 4

Language: English

DOI: 10.29309/TPMJ/2023.30.04.7446

Keywords: HerniaMeshPara-umbilicalProstheticTissue Repair

Categories

Abstract

Objective: To compare the outcomes of prosthetic repair and tissue repair in the emergency management of acutely incarcerated para-umbilical hernia (PUH). Study Design: Randomized Clinical Trial. Setting: Department of Surgery, DHQ Hospital KDA Kohat, Pakistan. Period: July 2021 to December 2022. Material & Methods: A total of 40 patients (20 in each group) of either gender aged above 18 years with acutely incarcerated PUH undergoing emergency management were randomized in to either mesh repair or tissue repair. The length of the procedure, the hospital stay following the procedure, and any postoperative issues were noted up till 6 months post-operatively. Results: In a total of 40 patients, 35 (87.5%) were female. The difference in the mean operating times for prosthetic repair group and tissue repair group were significantly different (97.2±15.2 minutes vs. 66.2±15.2 minutes, p<0.0001). Duration of incarceration and characteristics of the defect were statistically similar (p>0.05). Postoperative complications were encountered in 6 (30.0%) patients in prosthetic repair groups versus (25.0%) in tissue repair groups while the difference between various complications were found to be statistically insignificant (p>0.05). Throughout the course of the trial, there were no permanent difficulties caused by the mesh and none of the mesh had to be taken out. Conclusion: The use of prosthetic repair for emergency management of incarcerated PUH was safer and resulted in better outcomes as compared to conventional tissue repair.


Research Objective

To compare the outcomes of prosthetic repair and tissue repair in the emergency management of acutely incarcerated para-umbilical hernia (PUH).


Methodology

Randomized Clinical Trial conducted at the Department of Surgery, DHQ Hospital KDA Kohat, Pakistan, from July 2021 to December 2022. 40 patients (20 in each group) aged above 18 years with acutely incarcerated PUH were randomized into mesh repair or tissue repair groups. Outcomes measured included length of procedure, hospital stay, and postoperative issues up to 6 months post-operatively.

Methodology Flowchart
                        graph TD;
    A["Recruit 40 patients with acutely incarcerated PUH"] --> B["Randomize patients"];
    B --> C["Group 1: Prosthetic Repair n=20"];
    B --> D["Group 2: Tissue Repair n=20"];
    C --> E["Perform surgery and record procedure length"];
    D --> E;
    E --> F["Record hospital stay"];
    F --> G["Monitor postoperative issues for 6 months"];
    G --> H["Analyze data and compare outcomes"];
    H --> I["Draw conclusions"];                    

Discussion

Prosthetic repair for incarcerated PUH in emergency settings showed good outcomes, with no significant mesh-related complications. The study suggests that prosthetic repair is safer and simpler to carry out, and not associated with significant systemic or mesh-related problems. Intestinal ischemia or necrosis requiring resection should not be considered contraindications for mesh repair.


Key Findings

The mean operating times were significantly different between the prosthetic repair group (97.2±15.2 minutes) and the tissue repair group (66.2±15.2 minutes) (p<0.0001). Postoperative complications were encountered in 30.0% of patients in the prosthetic repair group versus 25.0% in the tissue repair group, with the difference being statistically insignificant (p>0.05). No permanent mesh-related difficulties or mesh removals were reported.


Conclusion

The use of prosthetic repair for the emergency management of incarcerated PUH is safer and results in better outcomes compared to conventional tissue repair.


Fact Check

1. A total of 40 patients were included in the study, with 20 in each group.
2. The study period was from July 2021 to December 2022.
3. 87.5% of the patients were female.


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