Haematological manifestations in primary hyperparathyroidism.

Background & objectives: Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by the elevated secretion of the parathormone (PTH). The aim of this study was to evaluate the haematological manifestations of PHPT in patients with normal renal functions who were treated surgically for parathyroid adenomas. Methods: In this retrospective cross-sectional study, 134 patients with normal renal functions who underwent parathyroidectomies for PHPT were included. The haematological manifestations were evaluated in the total study cohort and in the two groups of different calcium (Ca) levels (Group 1 ≤11.2 mg/dl and Group 2 >11.2 mg/dl). Results: The overall prevalence of anaemia, leucopenia and thrombocytopenia was 20.1, 6.7 and 6.0 per cent, respectively. Normocytic anaemia was present in 19 (14.2%) patients. There were no significant differences in the prevalence of anaemia, leucopenia and thrombocytopenia between the two groups. There were no correlations between the PTH levels and the leukocyte, haemoglobin or platelet values. Six to 12 months after the parathyroidectomy (PTX), 35.7 per cent of the patients with anaemia, 85.7 per cent of the patients with leucopenia and 100 per cent of the patients with thrombocytopenia had recovered. Interpretation & conclusions: In the present study, anaemia was seen with a variable frequency in PHPT, but there was no relationship between anaemia and high PTH or Ca levels. The development of anaemia can be seen regardless of the PTH levels in PHPT patients with normal renal functions. High-resolution rates after PTX indicate a possible association between PHPT and thrombocytopenia or leucopenia, although their prevalence is low in PHPT.

Timing of laparoscopic cholecystectomy in patients with non-severe biliary pancreatitis.

Introduction: In patients with acute biliary pancreatitis (ABP), cholecystectomy is mandatory to prevent further biliary events, but the precise timing of laparoscopic cholecystectomy (LC) for non-severe disease remain a subject of ongoing debate. Aim: To prove which method - early or delayed LC - is the method of choice in the non-severe disease by examining rates of gallstone-related complications, dissection difficulty, conversion rate, morbidity, mortality, and length of hospital stay. Material and methods: We retrospectively analysed the data of patients diagnosed with non-severe ABP, who were followed and underwent LC in our department. Patients who met the inclusion criteria were divided in to the early (< 2 weeks) and the delayed groups (> 2 weeks). Results: The patients in the early and delayed groups (n = 43/39) were similar in terms of demographic characteristics, comorbidities, and severity of biliary pancreatitis. The mean time to surgery was 1.7 vs. 6.5 weeks in the early and late groups, respectively. Patients in the delayed group had a 17.9% readmission rate. The causes were acute pancreatitis (10.2%), cholangitis, and cholecystitis. The conversion and the difficult dissection rates were 11.6% vs. 12.8% and 13.95% vs. 20.51% in the early and delayed groups, respectively. Mortality was not observed in the groups. Morbidity rates were 4.6% vs. 5%, and mean length of hospital stay was 10 vs. 17 days in the early and delayed groups, respectively. Conclusions: Delayed LC increases the rate of biliary events and early LC does not increase the operative difficulty or morbidity in patients with ABP.

Clinicopathological variables that correlate with sestamibi positivity in uniglandular parathyroid disease: a retrospective analysis of 378 parathyroid adenomas.

PURPOSE: Technetium-99 m sestamibi parathyroid scintigraphy (MIBI scan) has been used to localize abnormal glands in patients with primary hyperparathyroidism to guide parathyroidectomy. This series aimed to identify the biochemical and histopathological correlates of MIBI scan findings in patients with parathyroid adenoma. METHODS: A total of 378 patients with histologically and biochemically proven parathyroid adenoma were included. The results of MIBI scan, histopathological (gland volume and weight, oxyphil cell ratio), biochemical (blood and 24 h urine calcium, creatinine, glomerular filtration rate, parathormone, alkaline phosphate, and vitamin D3) variables were recorded. A positive uptake on the MIBI scan referred to a localized adenoma. Among histological variables, a cutoff of 30% was applied to define parathyroid adenomas with low (≤ 30%) and high (> 30%) oxyphil cell content. Statistical analyses were performed to assess the relationship among variables. RESULTS: MIBI scan localized the adenoma in 306 patients. Parathyroid gland volume and weight, and oxyphil ratio were significantly higher in the MIBI scan-positive group. Among the biochemical variables, only PTH was found to be significantly increased in the MIBI scan-positive group. Binary logistic regression models identified statistically significant cutoffs for the gland volume (1700 mm3), gland weight (1.3 g) and PTH levels (170 pg/mL) that can be used to predict the MIBI scan positivity. CONCLUSION: In addition to PTH levels, this series underscored the impact of cellular composition along with the parathyroid gland volume and weight, both of which correlate with sestamibi positivity in patients with benign uniglandular parathyroid disease.

An intraoperative serum parathormone level study in patients with chronic renal failure that underwent subtotal parathyroidectomy What extent of decrease is sufficient at which moment?

AIM: The aim of this study is to determine when to perform intraoperative parathormone (ioPTH) measurement and what extent of decrease in intraoperative serum PTH concentrations indicate success in the operations performed on patients with SHPT associated with chronic renal failure. MATERIAL AND METHODS: 50 consecutive patients who underwent subtotal parathyroidectomy between January 2012 and January 2019 were retrospectively included in this study. Patients were grouped according to persistent hyper parathyroidism (Group1, n:6) and curative surgery (Group 2, n:44). Preoperative serum PTH, calcium, phosphorus and ALP concentrations, intraoperative serum PTH concentrations; and serum PTH, calcium, phosphorus and ALP concentrations of 24th hour after surgery were included to the study. Intraoperatively, 20 minutes after parathyroid gland removal, blood was drawn for PTH assay. The changes in PTH levels between preoperative and intraoperative serum samples were calculated in percentage (ioPTH%) and postoperative 6th month serum PTH and ALP concentrations were included in the study. RESULTS: No significant differences were found by gender, BMI, elapsed period of dialysis treatment and preoperative laboratory values between Group 1 and Group 2. The meanage of Group 1 was 35 years which is lower than Group 2. With the second group, the mean decrease in PTH levels between intraoperative and preoperative serum samples (ioPTH%) was about 90%, which was higher than Group 1. CONCLUSIONS: In conclusion, we believe that, to encounter fewer persistent SHPT cases, it is essential that surgeons monitor ioPTH concentration 20 minutes after gland removal and confirm a decrease of 90% or more in ioPTH concentration. And we should not forget that young patients may tend to develop persistent SHPT. KEY WORDS: Chronic renal failure, Intraoperative parathormone, Secondary hyperparathyroidism, Parathyroidectomy, Subtotal patathyroidectomy.

Effects of preoperative calcium levels and parathyroidectomy on renal function in primary hyperparathyroidism: a retrospective study.

AIM: TTo assess the effects of preoperative calcium levels and parathyroidectomy on estimated glomerular filtration rate (eGFR) in patients of primary hyperparathyroidism (PHPT) with mild renal dysfunction or normal renal function. METHODS: This retrospective study enrolled 71 patients who underwent parathyroidectomy for PHPT in the General Surgery Department at Ondokuz Mayis University Hospital from 2010 to 2018. All patients were histopathologically diagnosed with parathyroid adenoma. Total serum calcium, serum creatinine, serum intact parathyroid hormone (PTH), and serum 25-hydroxyvitamin D3 (25(OH)D3) were measured before and 3-6 months after surgery. Patients were assigned to the low eGFR group (60-90 mL/min/1.73 m2) or normal eGFR group (≥90 mL/min/1.73 m2) and to the low calcium group (≤11.2 mg/dL) or high calcium group (>11.2 mg/dL). RESULTS: In the low eGFR and high calcium group, there were significantly more patients with hypertension and older age. In the normal eGFR and high calcium group, eGFR was significantly reduced after surgery. Independent predictors of eGFR change after surgery were age, pre- parathyroidectomy calcium, and pre-parathyroidectomy eGFR. CONCLUSIONS: After surgery, patients with low eGFR had preserved renal function, whereas those with normal eGFR had decreased renal function. Mild renal dysfunction in PHPT was associated with older age, hypertension, and high calcium levels.

The diagnostic value of 4D MRI at 3T for the localization of parathyroid adenomas.

PURPOSE: The aim of this study was to assess the feasibility of four-dimensional magnetic resonance imaging (4D MRI) at 3 T for the localization of parathyroid adenomas. MATERIALS AND METHODS: Preoperative 4D MRI scans, encompassing dynamic contrast-enhanced (DCE) sequences and non-contrast enhanced (non-CE) sequences, including a T2-weighted multipoint Dixon (T2-mDixon) sequence, with in-phase, out-phase, and water-only images, were evaluated retrospectively in 41 patients with surgically proven parathyroid lesions. Two readers who were blinded to the surgical findings independently reviewed the images in two sessions (non-CE sequences alone and non-CE + DCE sequences). The MRI localization of the suspected adenoma in each session and the consensus interpretation of the MRI images, were compared with the surgical results and interobserver agreement was assessed. RESULTS: By interpreting the non-CE sequences alone, reader 1 correctly localized 34 parathyroid lesions (sensitivity 81.0%, positive predictive value (PPV) 87.2%), and reader 2 correctly localized 34 parathyroid lesions (sensitivity 81.0%, PPV 91.9%). With the addition of DCE sequences, reader 1 correctly identified 35 parathyroid lesions (sensitivity 83.3%, PPV 87.5%), while reader 2 correctly identified 36 parathyroid lesions (sensitivity 85.7%, PPV 92.3%). Overall, MRI detected 38 parathyroid lesions (sensitivity 90.5%, PPV 95.0%). Interobserver agreement was slightly superior in non-CE + DCE sequences compared to non-CE sequences alone (ĸ = 0.796 vs. ĸ = 0.738). CONCLUSION: 4D MRI with DCE sequencing is a reliable method for the localization of parathyroid adenomas.

The diagnostic value of shear wave elastography for parathyroid lesions and comparison with cervical lymph nodes.

AIMS: The aim of this study was to prospectively assess the feasibility of the Virtual Touch tissue imaging quantification (VTIQ) method of shear wave elastography (SWE) for the discrimination of parathyroid lesions and to compare the lesions' stiffness with that of cervical lymph nodes. MATERIALS AND METHODS: SWE using VTIQ was performed on 66 patients with 87 histopathologically proven parathyroid lesions (54 parathyroid adenomas and 33 parathyroid hyperplasia) and 29 patients with 31 inflammatory cervical lymph nodes. The mean SWVs of the lesions were compared and receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance. RESULTS: The mean SWV of parathyroid adenomas (2.16±0.33 m/s) differed significantly from those of parathyroid hyperplasia and lymph nodes (1.75±0.28 m/s and 1.86±0.37 m/s respectively, p<0.001). Selecting a cutoff value of 1.92 m/s for diagnosing adenoma led to 80% sensitivity and 82% specificity (area under the curve [AUC]: 0.832 [95% confidence interval (CI): 0.742-0.921], p< 0.001). CONCLUSIONS: The VTIQ method of SWE can contribute to the differentiation of parathyroid adenoma from parathyroid hyperplasia and cervical lymphnodes.

Intraoperative nerve monitoring in thyroid surgery.

BACKGROUND: Nerve injury is one of the specific complications of thyroid surgery despite many advances in surgical technique. The recurrent laryngeal nerve (RLN) and the external branch of superior laryngeal nerve are the nerves at risk during thyroid surgery (1). Morbidity related to recurrent laryngeal nerve injury varies from changes in voice quality to severe dyspnea requiring tracheal intubation or tracheostomy. To minimize the risk of nerve injury, intraoperative nerve monitoring (IONM) being suggested as a tool for helping visual control for RLN has gained significant interest in recent years (1,2). We aimed to determine the effectiveness of nerve monitoring during thyroid surgery and to provide a clinical experience. MATERIALS AND METHODS: This study was performed from June 2010 to June 2012. We prospectively evaluated 94 patients who had thyroid surgery with or without nerve monitoring. Of those patients 48 were in monitored group (M) and 46 were in unmonitored group (UM). RESULTS: The mean age was 48 (27-76) in M group and 52 (73-17) in UM. There was only one patient had transient hoarseness in M group and also one patient had transient hoarseness in UM group. One each in both groups had persistent hoarseness. No patients experienced airway problem. Operation time was significantly shorter in M group (p<0.001). CONCLUSIONS: Use of a nerve monitoring system does not substitute for careful dissection and visual identification of nerves, but monitoring can assist the surgeon in identifying the RLN anatomic variability and may decrease the operation time during thyroid surgery.

Spigelian hernia: our experience and review of the literature.

BACKGROUND: Spigelian hernia is an uncommon and rare abdominal wall defect. We present our series of patients with Spigelian hernia and a literature review. METHODS: We carried out a retrospective review of patients operated on from 2005 to 2011 at Ondokuz Mayis University Medical Faculty Department of General Surgery. Epidemiological aspects, diagnostic methods, surgical techniques, morbidity, hospital stay, recurrences and follow up were analyzed. RESULTS: We have treated 9 patients, 7 female and 2 male, with a mean age of 64 (range 47-81) years. Right side was the most frequent location. Risk factors were present in 77.8% of patients. Diagnosis was made clinically in 7 of 9 cases but preoperative imaging was made in all patients for obtain detailed information about the defect. Open hernioplasty with polypropylene mesh placed over the external oblique aponeurosis constitutes the most frequent technique (44.5%) used by repair with a primary suturation (33.3%). The remaining 22.2% of cases were laparoscopic hernioplasty placing intraperitoneal position a mesh (22.2%). Mean hospital stay was 5.1 days (range 2-9), however if we look the laparoscopic cases the time decreased to 2.5 days. One recurrence was noted during the 15th month of follow-up, which has already been operated on. The mean follow-up period of this study was 58 months. No mortality was observed among patients. CONCLUSIONS: Spigelian hernia is rare and requires a high index of suspicion given the lack of consistent symptoms and signs. The physician should secure the diagnosis combining a proper history and physical examination with the preoperative imaging. Surgical technique depends on patient characteristics, type of hernia and surgeon experience.

The predictivity of serum biochemical markers in acute biliary pancreatitis.

Background and Aim. There are no accurate methods of differentiating acute biliary pancreatitis. Obstructions of biliary ducts, idiopathic pancreatitis may be related with biliary origin which needs identification for acute treatment. We searched for the predictivity of biochemical markers in early acute biliary pancreatitis. Patients and Methods. Serum levels of AST (Aspartate Transaminase),ALT (Alanine Transaminase), ALP (Alkaline Phosphatase), GGT (Gamma Glutamyl Transferase), total bilirubin, direct bilirubin, LDH (Lactate Dehydrogenase), amylase, lipase, CRP (C-Reactive Protein) and WBC (White Blood Cell) were measured in 157 patients with acute pancreatitis. Biliary and nonbiliary pancreatitis were differentiated by Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), Intraoperative Cholangiopancreatography (IOC). Cut-off points of admission biochemical markers with sensitivity, specifity, positive predictive value and negative predictive value were determined after identification of significant variables. Receiver Operator Curves were plotted for each biochemical marker. Results. Serum Alkaline Phosphatase, total bilirubin, direct bilirubin, amylase and lipase levels were significantly higher in biliary pancreatitis with a positive predictive value of 80.8%, 83.9%, 81.6%, 78.8%, 79.7%. Conclusion. Increased Alkaline Phosphatase,total bilirubin, direct bilirubin, amylase and lipase levels may be used in prediction of biliary pancreatitis.

Is oval flap reconstruction a good modification for treating pilonidal sinuses?

BACKGROUND: Flap techniques are acceptable for the surgical treatment of pilonidal sinuses. This study assessed a new modification of the rhomboid flap technique. METHODS: The study included 133 patients with pilonidal disease who were treated between April 2004 and April 2009. The pilonidal sinus was removed with an oval excision, and an oval head rhomboid flap was prepared to reduce flap necrosis. RESULTS: The mean age of the patients was 27.4 ± 4.6 years (range, 13-80). The rate of minor postoperative complications was 11.3%. The mean hospital stay was 2.3 ± .8 days (range, 1-6). The rate of recurrence was 1.5%. Regarding cosmetic results, 116 (87%) patients were very pleased, 15 (11.2%) were pleased, and 5 (3%) were displeased. The mean follow-up period was 22.5 ± 12.4 months (range, 5-57). CONCLUSIONS: The oval flap reconstruction method is a recommended procedure that produces fewer ischemic flaps with a low rate of recurrence and acceptable cosmesis.

Protective effects of etanercept and methylprednisolone on pancreatic damage in cerulein-induced acute pancreatitis.

OBJECTIVE: To examine the pharmacological effect of etanercept and methylprednisolone (MP) on acute pancreatitis (AP) induced by cerulein in an experimental rat model. METHODS: The present study was carried out in the Experimental Research Center, Ondokuz Mayis University, Samsun, Turkey between December 2008 and October 2009. Forty adult Sprague-Dawley rats were divided into 5 groups (n=8): 1--sham, 2--cerulein induced pancreatitis (over 20 hours), 3--etanercept (5 mg/kg, intraperitoneal), 4--MP (10 mg/kg, intramuscular), 5--etanercept plus MP. The rats in groups 3, 4, and 5 were cerulein-induced pancreatitis at 20 hours, as well. After the treatment, the pancreas and blood were taken for histopathological and biochemical analysis. RESULTS: All cerulein-treated rats developed biochemical and histopathological AP after 20 hours. Histological findings of pancreatitis and serum levels of amylase and lipase were lower in group 5 compared to group 2. Pancreatic inflammation and total pathological score were statistically reduced in the tissues of the pancreas at 20 hours after the treatment of etanercept plus MP in group 5 compared to groups 2, 3, and 4. CONCLUSION: In the early stage of cerulein induced AP, the administration of etanercept plus MP attenuated pancreatic inflammation and significant damage in rats.

Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis.

AIM: To determine factors related to disease severity, mortality and morbidity in acute pancreatitis. METHODS: One hundred and ninety-nine consecutive patients were admitted with the diagnosis of acute pancreatitis (AP) in a 5-year period (1998-2002). In a prospective design, demographic data, etiology, mean hospital admission time, clinical, radiological, biochemical findings, treatment modalities, mortality and morbidity were recorded. Endocrine insufficiency was investigated with oral glucose tolerance test. The relations between these parameters, scoring systems (Ranson, Imrie and APACHE II) and patients' outcome were determined by using invariable tests and the receiver operating characteristics curve. RESULTS: One hundred patients were men and 99 were women; the mean age was 55 years. Biliary pancreatitis was the most common form, followed by idiopathic pancreatitis (53% and 26%, respectively). Sixty-three patients had severe pancreatitis and 136 had mild disease. Respiratory rate > 20/min, pulse rate > 90/min, increased C-reactive protein (CRP), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels, organ necrosis > 30% on computed tomography (CT) and leukocytosis were associated with severe disease. The rate of glucose intolerance, morbidity and mortality were 24.1%, 24.8% and 13.6%, respectively. CRP > 142 mg/L, BUN > 22 mg/dL, LDH > 667 U/L, base excess > -5, CT severity index > 3 and APACHE score > 8 were related to morbidity and mortality. CONCLUSION: APACHE II score, LDH, base excess and CT severity index have prognostic value and CRP is a reliable marker for predicting both mortality and morbidity.

Coumadin-induced renal and retroperitoneal hemorrhage.

PRINCIPLES: Coumadin-induced renal and retroperitoneal hemorrhages are rare. Clinical and laboratory findings are not specific for the diagnosis. Computed tomography (CT) has some advantages in the evaluation of these patients. The aim of this study is to report our experience regarding renal and retroperitoneal hemorrhage due to Coumadin, and describe clinical and CT findings, treatment, and prognosis of the patients. METHODS: We reviewed our CT archive to search patients with renal and retroperitoneal hemorrhage caused by Coumadin treatment retrospectively. A total of seven patients with Coumadin-induced renal and retroperitoneal hemorrhages were included in this study. RESULTS: Four patients had abdominal pain, two patients had hematuria, and one patient had abdominal pain and hematuria. There was retroperitoneal hemorrhage in three patients on abdominal CT. One patient had hemorrhage in the renal pelvis and the jejunum, another had hemorrhage in the renal pelvis and the perirenal area, and another had hemorrhage in the perirenal area and the retroperitoneal region. In the last patient with hematuria, there was no hemorrhage. None of the patients had a lesion-causing hemorrhage. Coumadin was stopped, and vitamin K and fresh-frozen plasma were given to patient. One patient with massive retroperitoneal hemorrhage died, whereas other patients were successfully treated using conservative approaches. CONCLUSIONS: Hematuria and abdominal pain are the most common complaints in Coumadin-induced renal and retroperitoneal hemorrhage. CT can be the first imaging modality in these patients due to its ability to directly evaluate all peritoneal and retroperitoneal structures. It also allows evaluation of any underlying lesion that can cause hemorrhage from the renal area and the urinary tract. Conservative treatment is the first choice, and prognosis is good when diagnosed early.

Videolaparoscopic treatment of hepatic hydatid cyst.

BACKGROUND/AIMS: Unroofing, cystopericystectomy, or cystic evaluation and omentoplasty have been used in videolaparoscopic treatment in hepatic hydatidosis since 1992. Currently it is shown that videolaparoscopic treatment has been carried out successfully in selected cases. METHODOLOGY: Fifteen hepatic hydatid cysts in 12 cases were treated by videolaparoscopic methods. Formerly in the 5 cases, the cysts were aspirated with a needle designed for a 5-mm trocar, leaving a cystic cavity that was tension-free, then scolicidal solution was injected and aspirated. In the last 7 patients an aspirator-grinder apparatus was used. Intraoperative ultrasonography was applied in all patients. RESULTS: All the cysts were treated by drainage and omentoplasty. In one case cystic cavity infection was diagnosed in the 2nd postoperative month (morbidity rate 8.33%). Another patient died due to cerebral hydatid cyst and multiple organ failure after the postoperative first month (mortality rate 8.33%). Operative mortality was not seen. CONCLUSIONS: Videolaparoscopic treatments of hepatic hydatid cysts may be carried out successfully in selected cases.

Results of alcohol and albendazole injections in hepatic hydatidosis: experimental study.

BACKGROUND: Percutaneous drainage with alcohol injection for hydatid cysts has been commonly used in the last two decades. Albendazole is the drug of choice in the medical treatment of hydatidosis, and has also been used as an intraoperative scolicidal solution. The side-effects of its local application are not well known and have not been investigated. The purpose of the present study was to investigate the effects of the intracystic injections of alcohol and albendazole solutions on the hydatid cysts and hepatobiliary system of rabbits. METHODS: There were three groups of eight rabbits: a control group, an alcohol group and an albendazole group. In all groups hepatic hydatidosis was obtained. The control group received no therapeutic procedure. Cyst liquid was aspirated, and alcohol or albendazole solutions were injected in the other two study groups. alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) levels, echinococcus indirect hemagglutination (IHA) tests, and the size and volume of the residual cysts were investigated. Liver was histopathologically evaluated. RESULTS: The ALT, AST, GGT, and alkaline phosphatase (ALP) levels were significantly higher in the alcohol group, whereas echinococcus IHA level was highest in the control group than in the study groups. Albendazole had similar effects but of a lesser degree (P < 0.01). After therapy, the cyst volume was greater in the control than in the albendazole group (P < 0.01). In histopathological evaluation hepatocellular necrosis, portal inflammation and fibrosis were most severe in the alcohol group (P < 0.01). CONCLUSIONS: Alcohol and albendazole solutions are effective as scolicidal solutions. Higher scolicidal effect and lesser side-effects on hepatobiliary system are the advantages of albendazole solution.

Acute pancreatitis caused by leptospirosis: report of two cases.

Two cases of acute pancreatitis with leptospirosis are reported in this article. CASE 1: A 68-year-old woman, presented initially with abdominal pain, nausea, vomiting, and jaundice. She was in poor general condition, and had acute abdominal signs and symptoms on physical examination. Emergency laparotomy was performed, acute pancreatitis and leptospirosis were diagnosed on the basis of surgical findings and serological tests. The patient died on postoperative d 6. CASE 2: A 62-year-old man, presented with fever, jaundice, nausea, vomiting, and malaise. Acute pancreatitis associated with leptospirosis was diagnosed, according to abdominal CT scanning and serological tests. The patient recovered fully with antibiotic treatment and nutritional support within 19 d.

Umbilical hernia repair with the prolene hernia system.

BACKGROUND: Despite its extensive application for the repair of inguinal hernias, the use of the Prolene Hernia System (PHS; Ethicon, West Somerville, NJ) for the repair of umbilical hernias has been sparse. The purpose of this prospective study was to assess, in comparison with currently available techniques, the effectiveness of the PHS in repairing umbilical hernias. METHODS: Fifty consecutive patients diagnosed with a primary umbilical hernia were enrolled for the study. They were randomized and underwent elective repair of umbilical hernia using either the PHS (n = 17), Mayo repair (n = 18), or onlay repair with mesh (n = 15). Data for the time required for the surgical repair method, length of hospital stay, postoperative pain, analgesic necessity, and return to work, and early and late complications were recorded, and compared with respect to the repair procedure. RESULTS: The mean operating time and the mean length of hospital stay were the longest in the onlay repair with mesh group (P < .05). Those patients operated on using the PHS described minimum pain on the postoperative first , second, and seventh days (P < .05) and also the necessity of analgesic was significantly lower in this group (P < .05). There were 2 recurrences in Mayo repair group. The mean follow-up duration was 22 months (range 6 to 44 months). CONCLUSION: The PHS seemed to be useful for umbilical hernia repairs in selected patients as it caused minimal postoperative pain and less analgesic necessity.