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Journal of Postgraduate Medicine
Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India
ISSN: 0022-3859 EISSN: 0972-2823
Vol. 54, Num. 1, 2008, pp. 59-59

Journal of Postgraduate Medicine, Vol. 54, No. 1, January-March, 2008, pp. 59

Letter

Authors' reply

Kamer E, Unalp HR, Derici H, Tansug T, Onal MA

Department of Surgery, Izmir Ataturk Training and Research Hospital, Izmir
Correspondence Address:Department of Surgery, Izmir Ataturk Training and Research Hospital, Izmir, erdinc.kamer@gmail.com

Code Number: jp08021

Sir,

In adults, umbilical hernia is a relatively common condition. It is mostly seen in obese women, often due to multiparity and in the patients with cirrhosis. [1] However, only a limited number of studies have reported short- and long-term outcomes of umbilical hernia repair (UHR) performed simultaneously with laparoscopic cholecystectomy (LC). The prevalence of cholelithiasis accompanied by umbilical hernia varies between 4.7 and 18%. [2] Our study was carried out to determine the ideal method for hernia repair in patients undergoing LC and elucidate potential problems with LC.

Several predisposing factors have been shown to be associated with a higher risk of umbilical hernia recurrence. These include hernia-related variables, such as diameter; surgery-related variables, such as type of repair and occurrence of postoperative infection; and patient-related variables, such as gender, obesity, genetics, co-morbidity (such as diabetes mellitus type 2, hyperlipidemia, human immunodeficiency virus), drugs, or lifestyle factors. [3],[4] Surgical technique and body mass index (BMI) are the most frequently studied factors and there have been several reports on their impact on recurrence. [3],[4],[5] It is not always possible to assess all the risk factors in retrospective studies.

Although obesity is reported to be strongly predictive for post-surgical hernia recurrence, [3] the exact mechanism for this association has not been determined. It remains unclear whether obesity is an indicator of an inherent defect of tissue structure and healing, whether obesity leads to hernia due to increased intra-abdominal pressure, or whether hernia repair is technically more demanding in obese patients. [3] Although Asolati et al. may not have been successful in establishing a clear relationship between increased BMI and umbilical hernia recurrence; [4] there are other authors who have, in fact, found a correlation between the two. [5],[6],[7],[8]

Although serum leptin levels may have a role in measuring adiposity; [9],[10] these are not routinely determined in patients undergoing LC and/or UHR. Hence, we could not study the role this factor in our retrospective study.

References

1.Arroyo Sebastian A, Perez F, Serrano P, Costa D, Oliver I, Ferrer R, et al . Is prosthetic umbilical hernia repair bound to replace primary herniorrhaphy in the adult patient? Hernia 2002;6:175-7.  Back to cited text no. 1    
2.Kamer E, Unalp HR, Derici H, Tansug T, Onal MA. Laparoscopic cholecystectomy accompanied by simultaneous umbilical hernia repair: A retrospective study. J Postgrad Med 2007;53:176-80.   Back to cited text no. 2    
3.Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A. Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 2004;8:42-6.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Asolati M, Huerta S, Sarosi G, Harmon R, Bell C, Anthony T. Predictors of recurrence in veteran patients with umbilical hernia: Single center experience. Am J Surg 2006;192:627-30.   Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Halm JA, Heisterkamp J, Veen HF, Weidema WF. Long-term follow-up after umbilical hernia repair: Are there risk factors for recurrence after simple and mesh repair? Hernia 2005;9:334-7.   Back to cited text no. 5  [PUBMED]  
6.Arroyo A, Garcia P, Perez F, Andreu J, Candela F, Calpena R. Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults. Br J Surg 2001;88:1321-3.  Back to cited text no. 6    
7.Pescovitz MD. Umbilical hernia repair in patients with cirrhosis. No evidence for increased incidence of variceal bleeding. Ann Surg 1984;199:325-7.   Back to cited text no. 7    
8.Sanjay P, Reid TD, Davies EL, Arumugam PJ, Woodward A. Retrospective comparison of mesh and sutured repair for adult umbilical hernias. Hernia 2005;9:248-51.   Back to cited text no. 8  [PUBMED]  
9.Ruhl CE, Harris TB, Ding J, Goodpaster BH, Kanaya AM, Kritchevsky SB, et al . Body mass index and serum leptin concentration independently estimate percentage body fat in older adults. Am J Clin Nutr 2007;85:1121-6.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Das S. Simultaneous umbilical hernia repair in patients undergoing laparoscopic cholecystectomy: Is Obesity a risk factor for recurrence? J Postgrad Med 2008;54:58-9.  Back to cited text no. 10    

Copyright 2008 - Journal of Postgraduate Medicine

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