Introduction
An umbilical hernia is a discontinuity of the abdominal wall at the umbilicus with protrusion of any of the abdominal contents into the hernia sac formed by the skin and surrounding subcutaneous tissue [1]. An umbilical hernia is among the congenital malformations most frequently reported in buffalo calves [2–4] due to improper closure of the umbilicus at birth [5].
Surgical repair to restore the integrity of the abdominal wall and prevent incarceration and strangulation of hernia content by primary appositional suture herniorrhaphy repair [6]; however, dehiscence and recurrence are frequently the major complications as the navel area is always subjected to internal abdominal pressure with subsequent lack of healing of the suture line. Therefore, prosthetic synthetic mesh reconstruction was an optimum solution [7,8].
Quite recently, a prosthetic-based hybrid mesh hernioplasty has been successfully utilized for repairing abdominal wall defects and perineal hernia in dogs without complications [9,10].
The objective of the present study was to evaluate the newly developed multifunctional prosthetic polyester-based hybrid mesh [9] in hernioplasty for repairing clinical cases of umbilical hernias in buffalo calves.
Material and Methods
Seven buffalo calves (four females and three males) of 4–8 months of age and weighed 70–100 kg, were presented with umbilical swellings since birth which were increasing in size with time, to the surgery clinic of the Faculty of Veterinary Medicine, Benha University, Qaliubya, Egypt (Fig. 1). Physical and ultrasonography confirmed the presence of reducible umbilical hernias with a remarkable ring of 10–16 cm in diameter. Two females of the present cases were previously subjected to unsuccessful primary suture herniorrhaphy with subsequent suture dehiscence. Hernioplasty with prosthetic mesh was recommended. Preoperative examination revealed normal physiological parameters. The calves were fasted for 24 hours prior to their operations.
The mesh used for hernia repair
The used mesh is a hybrid platform of both synthetic and natural materials with its backbone consisting of a synthetic commercial polyester fabric of very low cost (one square meter of the raw fabric does not exceed one dollar), incorporating natural biomaterial nanocarriers loaded with antibacterial drug ciprofloxacin and healing promotor phenytoin [10].
Preoperative preparation
The calves were secured in dorsal recumbency after being sedated with IM 0.05 mg/kg Xlazine HCl (Xylaject, Adwia, Egypt). The surgical site was aseptically prepared and circularly infiltrated with 2% Lidocaine (Debocaine, Aldebiky, Egypt).
Surgical technique
A similar technique utilized by the authors in previous works with the same mesh [9,10], was used by making an elliptical skin incision over the hernia sac to expose the hernia ring The hernia sac was carefully opened to reposition the herniated viscera. The hernia ring was revitalized by trimming its edges. The used mesh was folded and trimmed to match the hernia ring and surpass its edges by 1–2 cm. An omental pedicle was retrieved and fixed with individual stitches of polypropylene one suture material (Prolene-Ethicon, Germany) to the perimeter of the mesh, leaving adequate suture strands which were then anchored to the perimeter of the hernia ring periphery. For better fixation and stabilization of the mesh, a few stitches of the same suture material were placed along the ring periphery. The subcutaneous abdominal fascia was closed over the mesh with a continuous suture pattern using polyglactin 1 (Vicryl, Germany). The skin was closed after excising the excess part with a mattress pattern using silk 2 (Ethicon, Germany). An abdominal sterile bandage was applied to protect the surgical site (Fig. 2).
Figure 1.
Umbilical hernia in a buffalo calve.
Post-operative care
The operated animals were maintained on half the amount of the presented soft diet and ceprofluxacin IM antibiotics 20 mg/kg (Cefotax, Adwia, Egypt) for 7 days. The skin sutures were removed after 10 days. All buffalo calves had an ordinary uneventful recovery without wound dehiscence, recurrence, or infection for 3 months of follow-ups.
Results and Discussion
In the present study, the presented cases were diagnosed as reducible umbilical hernias from the history, clinically, and ultrasonography. All cases were congenital in origin due to the failure of closure of the umbilical ring. The genetic influence on the incidence of umbilical hernia has been reported [4,11]. Primary closure herniorrhaphy [12] was among the surgical techniques used for umbilical hernia repair; however, the technique is always associated with wound dehiscence and recurrence. Also, gender affects the incidence of umbilical hernia. Females showed a higher incidence than males in the present study. Adopting the polyester–based hybrid mesh hernioplasty for repairing the umbilical hernia ring in the present study, provided efficient healing with excellent biocompatibility without any complications. The use of prosthetic mesh in such types of hernias with large or even small diameter support the ventral abdominal muscle to bear the weight of abdominal viscera to avoid suture dehiscence or recurrence. The intra-peritoneal prosthetic mesh implantation with omentalization was healed without any visceral adhesions. This is agreed with previous reports [8–10]. The material from which the prosthetic mesh is made is commercially available polyester at a very low price loaded with nano-biomaterials to promote healing, and antimicrobial effect [10]. In a previous experimental study, histopathological evaluation on tissue samples from animals with mesh hernioplasty proved the mesh biocompatibility, stability, limited inflammatory and hypoallergenic reactions, and very low costs [10]. The traditional surgical Polypropylene mesh which is a polymer of cyclic hydrocarbons was used in previous studies but at a high cost [9,13].
Figure 2.
Prosthetic hybrid mesh implantation.
Conflict of interest
The authors declare that no conflict of interest.
