A simple modified technique for repair of umbilical hernia in patients undergo laparoscopic cholecystectomy. Report of 10 cases.

BACKGROUND AND AIM: Umbilical hernia frequently accompanies cholelithiasis. It is possible to repair these hernias after completing cholecystectomy. We herein describe a simple modified technique for the repair. PATIENTS AND METHOD: The technique was applied to 10 patients undergone laparoscopic cholecystectomy. After cholecystectomy has been performed, periumbilical trocar incision is extended toward the umbilicus. The hernia sac is sent into the abdominal cavity and one or two simple sutures are put to approximate the fascial edges of the umbilical hernia. A similar approximation is done for trocar hole. A piece of polypropylene mesh covering both defects with an adequate overlap at four edges is fixed in onlay position. RESULTS: No wound complications were recorded. After a median of 23 months (6-40 months) follow-up no recurrence was observed. CONCLUSION: This simple modified repair may especially be useful in centers where the surgeons can easily perform cholecystectomy laparoscopically, but are not familiar with laparoscopic hernia repair and mesh placement or haven't the equipment and material necessary for a laparoscopic repair.

Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients.

OBJECTIVE: The study was designed to compare the early postoperative results of the commonly used two surgical flap procedures in pilonidal disease: Karydakis and Limberg. METHOD: One hundred patients were randomized into two groups and standard Limberg or Karydakis procedures were performed. All had primary sinus orifices. Infected cases and the ones with secondary orifices over 2 cm distant from primary were excluded. Data were recorded concerning complications, need for analgesia and wound dressing, periods of time off work and off driving. Patients were asked to classify their first defecation manner after the operation and also pain according to a Visual Analogue Scale with range of 1-10. RESULTS: There was a significantly higher wound infection rate in the Karydakis group than in the Limberg group (13/50 and 4/50 respectively). This also resulted in significantly higher values for wound dressings and need for analgesia. The time off work and off driving and also the Visual Analogue Scale scores were not significantly different between the two groups. CONCLUSION: Both procedures can be safely performed in pilonidal disease with a standard length of stay in hospital and a similar loss of productive power. However, the Karydakis flap seems to have a significant higher infection rate and this probably increases the cost.