Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated para-umbilical hernia: a prospective randomized study

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Abstract
Although prosthetic repair has become the gold standard for elective management of para-umbilical hernia (PUH) its use in the setting of acute incarceration is still limited for fear of prosthetic-related complications, mainly infection. The objective of this study was to compare results from prosthetic repair and tissue repair in the management of the acutely incarcerated PUH. Forty-two patients were prospectively randomized to either the prosthetic-repair group (group 1 = 21 patients) or the tissue-repair group (group 2 = 21 patients). In group 1, an onlay polypropylene mesh was inserted and the presence of non-viable intestine was not considered a contraindication for mesh repair. Operative time, postoperative hospital stay, and postoperative complications were recorded. Follow-up was performed by physical examination to detect recurrence. Mean operative time was significantly longer for group 1 (96.9 ± 14.6 compared with 65.5 ± 14.6 min for group 2, P < 0.05). Postoperative hospital stay did not differ significantly between the groups (3 ± 1.6 compared with 3.5 ± 2.2 days for groups 1 and 2, respectively). Postoperative complications did not differ significantly between the groups (28.6 vs. 23.8% for groups 1 and 2, respectively). No mesh had to be removed. At follow-up (mean 16 ± 5.5 months) there were four recurrences in group 2 (4/21, 19%) and no recurrences in group 1 (P < 0.05). Use of prosthetic repair for emergency management of incarcerated PUH is safe and leads to superior results, in terms of recurrence, compared with conventional tissue repair. The presence of non-viable intestine cannot, furthermore, be regarded as a contraindication for prosthetic repair.