A prospective observational study comparing conventional lateral border transfascial mesh fixation versus midline transfascial suturing in laparoscopic intraperitoneal onlay mesh repair for umbilical hernia- a pilot study.

BACKGROUND

Conventional lateral border transfascial mesh fixation in laparoscopic intraperitoneal onlay mesh (IPOM) repair for umbilical hernia is associated with significant postoperative pain due to nerve entrapment in the lateral abdominal musculature. Midline transfascial suturing, targeting the less-innervated linea alba, may offer improved pain outcomes without compromising mesh stability.

METHODS

This prospective observational study included 62 patients undergoing laparoscopic IPOM repair for primary umbilical hernia with defect size < 6 cm. Patients were allocated based on surgical unit protocol: 31 underwent midline transfascial suturing (Midline group) and 31 underwent conventional lateral border transfascial fixation (Lateral group). Primary outcomes were postoperative pain assessed by Visual Analogue Scale (VAS) at predetermined intervals (postoperative days 1, 2, 7, 14, and 60), operative time, and length of hospital stay. Secondary outcomes included recurrence, complications, and patient satisfaction using the Patient Satisfaction Questionnaire (PSQ).

RESULTS

Baseline demographics including age, gender, body mass index, and defect size were comparable between groups (p > 0.05). The Midline group demonstrated significantly lower VAS scores at all time points: POD1 (2.81 ± 0.64 vs. 4.32 ± 0.60, p = 0.001), POD7 (2.13 ± 0.50 vs. 3.23 ± 0.72, p = 0.001), and POD60 (0.52 ± 0.51 vs. 1.36 ± 0.66, p = 0.001). Hospital stay was significantly shorter in the Midline group (2.48 ± 0.51 vs. 3.48 ± 0.51 days, p = 0.001). Patient satisfaction scores were higher with midline fixation (8.76 ± 0.25 vs. 6.76 ± 0.25, p = 0.001). Operative time was comparable between groups (80.19 ± 12.27 vs. 81.52 ± 10.80 min, p = 0.654). Recurrence rates were similar (9.7% vs. 12.9%, p = 0.688). The Midline group had no complications, while the Lateral group had 16.1% (seroma 9.7%, surgical site infection 6.5%; p = 0.066).

CONCLUSION

Midline transfascial suturing in laparoscopic IPOM repair for umbilical hernia significantly reduces postoperative pain, shortens hospital stay, and improves patient satisfaction compared to conventional lateral border fixation, with comparable operative time and recurrence rates. This technique represents a patient-friendly alternative that should be considered for small-to-medium umbilical hernias.