Midline hernias comprise of epigastric,umbilical, paraumbilical and periumbilical port site hernias. Though these hernias appear to be small, yet they have a very high chance of developing complications. Surgical treatment may appear to be very easy but the recurrence rate with these methods is very high. Laparoscopic methods too have ahigh recurrence rate. Hence the need to develop a new method which envisages good anatomical repair accompanied by mesh reinforcement.

1. New technique for midline hernia repair.
(A combination of anatomical and mesh repair)
By
Dr. Ketan Vagholkar
MS, DNB, MRCS, FACS
Consultant General Surgeon
&
Professor of Surgery

2. Salient features of the new repair.
l Repair of midline hernias is a challenging problem.
l Midline hernias include epigastric, paraumbilical , umbilical and
periumbilical port site hernias.
l Traditional anatomical repairs have a high recurrence rate.
l Traditional mesh repair involves placement of the mesh by onlay technique
which has a high chance of infection and sinus formation.
l Laparoscopic approach has a high failure rate.
l A combination of anatomical and mesh repair has therefore been devised to
overcome the shortcomings in the various repairs.
l This involves creation of a new linea alba followed by placement of the
mesh on it but below the rectus muscle.
l The anterior rectus sheath is then closed over the rectus muscles ,thus
covering the mesh completely.

3. l Hernial sac dissected
upto the neck and
thereafter opened

4. l Sac closed with 2-0
vicryl
l Cuts made on the
anterior rectus sheath
parallel to the defect on
either side about 1 inch
longer than the size of
the defect
l Rectus muscle dissected
free and retracted
laterally.

5. l Flaps of anterior
rectus sheath thus
created approximated
in the midline by
continuous 1-0
prolene suture

6. l Prolene mesh placed on the
newly created linea alba and
made to extend beyond the
midline on either side and
vertically about an inch above
and below the defect.
l The mesh fixed with
interrupted 2-0 prolene
stitches to prvent migration.

7. l Negative suction
drain kept at the level
of the mesh and
brought out through a
separate opening
l The lateral edges of
the anterior rectus
sheath approximated
with 1-0 ethilon.

8. Results
l Paraumbilical & l Epigastric hernias
umbilical hernias
N= 52 N= 24
Recurrence rate nil (Mean follow up Recurrence rate nil (Mean follow up
period 12 months) period 12 months)
l Periumbilical Port
site incisional
hernias
N= 24
Recurrence rate nil (mean follow up
period 10 months)