Onlay hernioplasty versus Rives–Stoppa repair for management of paraumbilical hernia associated with divarication of recti in diabetic patients in terms of recurrence and surgical site infection. A prospective randomized controlled trial.

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Para-umbilical hernia is one of the common types of hernia. It has a female to male ratio of 5:1. Not uncommonly, para-umbilical is associated with divarication of recti which is separation of the two muscles, usually as a result of the linea alba thinning and stretching. There are many surgical procedures for repair of hernia; however,the recurrence rate remains the main expected consequence. Many studies proved the effect of diabetes on increasing surgical site infection which may affect the result of hernia repair especially when using prostheses. Repairs of the abdominal wall that use permanent prostheses differ based on where the prosthesis is placed anatomically. Onlay repair is one of the commonest repairs used to repair abdominal wall in which mesh is applied superficial to anterior rectus sheeths. Being an easy technique may be the cause of its wide practice. However, Onlay techniques have reported recurrence rates as high as 23% in cases with complex weak abdomen. In addition, locating the mesh in the subcutaneous space carries the risk of surgical site infection with subsequent fistulas or even recurrence. Rives–Stoppa repair, is technically difficult repair and involves retro muscular prefascial placement of a large mesh anterior to the posterior rectus sheath and primary closure of the anterior fascia. It has a theoretical advantage of keeping the mesh away from the wound and subsequently less liability of surgical site infection. The aim of this study is to compare between Onlay hernioplasty and Rives–Stoppa repair for management of paraumbilical hernia associated with divarication of recti in diabetic patients in terms of recurrence and surgical site infection.

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