1. Sublay H-shape mesh as a novel technique for repair of para umbilical hernia in obese patients
Ashraf I. Obaid, MD, PBGS, Karam M. Alslaibi, MD
Presented By
Dr. Karam M. Alslaibi
Department of General Surgery III in Shifa Medical Complex
April 2017

2. Presentation Outline Introduction Objective Methodology Results
Comparison with others
Conclusion

3. Introduction
Para umbilical hernia.
Risk Factors.
Methods for repair.

4. Introduction cont… 4% suture repair 10-30%. 10.7%
Based on literature review, the suture repair for PUH resulted in a high recurrence rates 10-30%.
The use of different kind of meshes can reduce this rate up to 4%. (Rituraj et al., 2016).
Higher patient’s body mass index >30 kg/m2 and hernia size of >2 cm are risk factors for para umbilical hernia recurrence.
Usage of suture repair in obese patient make the recurrence rate reach 18.3% (ANJUM et al., 2012).
Even with use of mesh, the recurrence rate in obese patient can reach 10.7%. (Linas Venclauskas et al., 2008).
Obese patients + mesh
Non obese patients + mesh 4%
suture repair
10-30%.
10.7%

5. Introduction cont…
Generally, the treatment of ventral hernia has changed drastically over the last 20 years. However, there is still some controversy concerning mesh positioning & operation methods.

6. Objective
To assess validity of sublay H shape mesh as a novel technique in repair of PUH in obese patients in terms of complications and recurrence.

7. Patient Selection Criteria
Methodology
Patient Selection Criteria
Including criteria:
All patients with PUH and BMI >30 kg/m2
Hernia size >2 cm.

8. General Considerations
Methodology
General Considerations
All patients were operated by using sublay H-shape mesh technique.
The size of mesh used was variable depending upon the size of the defect, mostly 10*8 cm size was used.
In this technique, polypropylene mesh was used to repair the defect.

9. Methodology
Surgical Technique
The hernias were repaired using a 6– 7-cm mid-midline incision
The hernial sac was identified and left in situ and reduced.
Elliptical incision around the defect on anterior rectus sheath. (Radius: 2- 3cm in horizontal direction and 3- 4cm in vertical direction).
Eversion of 2 flabs of anterior rectus sheath to close the hernial defect and stitch them with vicryl 0.
2-3 cm
3-4 cm

10. Methodology Surgical Technique
Dissection underneath the rectus muscle for preparing to put the mesh.
Making H-shape mesh and fix it in the midline above flabs, the 4 limbs were placed under the rectus muscle with at least 2cm up and down.
A subcutaneous hemovac drain was used in all patients & the skin was closed with absorbable subcuticular vicryl.
The operative, post operative complications and quality of life following surgery were all noted. Recurrence was diagnosed during follow up period, which was on average 36 months after discharge from the hospital.
≥ 2 cm

11. Results & Discussion

12. Result
Results
Gender

13. Additional Information
Results
Additional Information
Value
Element
41-63 year
Age group
38.5 kg/m2
Average BMI
36 months
Median follow up

14. Results
Complications

15. Comparison between current and other methods for repairing of PUH
Ref.
Recurrence
Wound infection
Seroma
hematoma
Average follow up
Median BMI
Number of pt.
Method of repair
Type of hernia
Location
(Rituraj, 2016)
10.3%
1.5 % ?
12 months
31.5 kg/m2
68 patients
Simple Suture Repair (mayo’s)
PUH
Jaipur
(India)
(Daudpoto, 2013)
2.7 %
11.1 %
2.7%
30 months
<30 kg/m2
36 patients
Onlay mesh
Karachi
(Pakistan)
(L.Venclauskas, 2008)
10.7%
2.1%
not available
>30 kg/m2
97 patients
Kaunas
(Lithuania)
Current Study
none
8.3%
16.5%
36 months
38.5 kg/m2
12 patients
Sublay H shape mesh
Gaza

16. Conclusion
A lower incidence of postoperative seromas, hematomas, infections, and other related complications is observed after using Sublay H- shape mesh technique for repair of PUH.
No recurrence rate is noted after repair of obese patients with this new technique.
According to our results, Sublay H-shape mesh technique can be used as a preferred choice of operation in obese patients with PUH.

17. THANK YOU