Background: The study was conducted to compare the onlay mesh repair with the preperitoneal mesh repair in adult patients with paraumbilical /umbilical hernias. Aim: The study compares the operative time, the hospital stay and postoperative complications and recurrence in onlay and preperitoneal mesh repair for umbilical hernia. It is a non randomized clinical trial. Method: 44 patients underwent mesh repair by onlay or preperitoneal. These patients were more than 18 years but less than 70 years of age. All the other hernias like groin hernia, incisional hernia, epigastric hernia, recurrent hernia and divercation of recti were excluded. A detailed history with demographic parameters were noted. Local examination and routine labs were done. After written informed valid consent patients underwent onlay or preperitoneal. In the postoperative period patients were monitored for immediate and long term complications upto 6 months. The results were statistically were analysed and tabulated into results. Results and discussion: Like most of the studies our results showed that operative time for preperitoneal is more than onlay repair. Althoughin our study the time of drain removal was almost same in contrast to the result of most studies where drain in the onlay repair group was removed before preperitoneal repair group. Patients of the preperitoneal group were discharged before the onlay group just like the result of most studies. Pain score (VAS ) showed preperitoneal group had less pain on day 3 compared with onlay group but both had similar pain score on day 1. Complications like seroma formation, surgical site infection and chronic pain was more in the onlay group as compared to preperitoneal group. There was no case of recurrence in our study. Conclusion: Umbilical hernias are less as compared to inguinal hernia and incisional hernia. Obesity remains the main risk factor and it occurs most commonly in middle age group 31–50 years. A mesh repair with non absorbable polypropelene mesh is the treatment of choice nowadays. A preperitoneal mesh repair demonstrates better outcomes in terms of hospital stay, severity of pain after day 3 and complications like seroma formation and surgical site infection as compared to onlay mesh repair. On long term follow up, a preperitoneal mesh repair shows less incidence of chronic pain and recurrence though more long term follow up warranted to validate the result.

Keywords: Umbilical Hernia; preperitoneal mesh repair; polypropelene mesh.