UMBILICAL HERNIAL DEFECTS ENCOUNTERED BEFORE AND AFTER ABDOMINAL LAPAROSCOPIC PROCEDURES

Pre-existing fascial umbilical defects may compound problems faced dur ing laparoscopic surgery. Detection helps in preventing bowel or oment al injury and repair can be done at the same time, Postoperative port incisional hernias are not uncommon and require surgical repair. Metho ds: The incidence, clinical features and management of such fascial de fects were studied in 2100 patients undergoing abdominal laparoscopy. Results: The incidence of fascial defects was 18%, The hernias were sy mptomatic in 56.5% cases, with an overwhelming female preponderance. A supraumbilical incision above the upper limit of the hernia was used to establish the umbilical port and through this the hernias were repa ired with nonabsorbable sutures, Postoperative incisional hernias occu rred in 41 patients out of a total follow-up of 1892 cases (2.16%). Th e common predisposing factors were wound infection, postoperative ches t infection and previous existing diseases, like diabetes and connecti ve tissue disorders. Twenty-eight patients underwent mesh plasty and 3 cases had laparoscopic Gortex mesh repair. The remaining 10 cases ref used surgery. Conclusions: Omental fascial defects should be dealt wit h at the same sitting through a supra-umbilical port incision avoiding direct entry into the hernia, Use of nonabsorbable sutures is recomme nded. Prevention of wound infection and postoperative chest infection greatly reduces the chances of an incisional hernia.