Onlay hernioplasty versus Rives–Stoppa repair for paraumbilical hernia associated with divarication of recti in diabetics in terms of recurrence and surgical site infection: a prospective randomized controlled trial

Purpose
The aim of this study was to compare between onlay hernioplasty and Rives–Stoppa repair (RS) for management of paraumbilical hernia associated with divarication of recti in diabetic patients in terms of recurrence and surgical site infection.
Patients and methods
A total of 60 diabetic patients with primary paraumbilical hernia and divarication of recti were randomly allocated into two groups: group I included 30 patients (mean age: 49.77±11.15 years) who were subjected to onlay repair and group II included 30 patients (mean age: 51.80±10.84 years) who were subjected to RS.
Results
Eight (26.7%) patients in group I showed superficial wound infection, of whom three (37.5%) progressed to mesh infection. Three (10%) patients in group II developed superficial wound infection, with no progression to mesh infection. Seroma occurred in five (16.7) cases in group I, compared with one case in group II. All were treated conservatively, except one patient in group I who was infected and later led to mesh infection. Late mesh infection occurred in one patient in group I and one patient in group two. Recurrence was encountered in five patients after onlay repair compared with one patient after RS. All recurrent cases were owing to mesh infection and its removal. After 1 year, visual analog scale showed no significant difference between both groups regarding chronic postoperative pain.
Conclusion
After 1-year follow-up, RS was favorable to onlay repair for management of diabetic patients with paraumbilical hernia and divarication of recti regarding recurrence and surgical site infection.