Variation in intra abdominal pressure between obese and non obese patients with umbilical hernias and patients with no abdominal pathologies

Introduction: Umbilical hernia repair, despite its perceived simplicity, is associated with recurrence between 2.7 and 27%, in mesh repair and non mesh repair respectively. Our hypothesis is that raised intra abdominal pressures (IAP) is a significant causative factor for the occurrence of umbilical hernias. Objectives: To study the correlation of IAP with BMI and occurrence of umbilical hernia Methods: Patients who consented to the study had multiple measurements of pre operative IAP taken using a manometer via the bladder after instilling 50 ml of normal saline. Other details were taken via a questionnaire and data was analyzed. Results: Variation of IAP at Valsalva between obese and non obese patients (BMI more than 30) in the hernia group was found to be significant with a p value of <0.001 ( Mean ± SD = 17.3 ± 1.6) Difference in IAP on Valsalva between patients with umbilical hernia and no abdominal pathologies was significant. A ROC curve with a cutoff of 14 was obtained with a sensitivity of 72% and a specificity of 81%. Conclusion: Our study showed a significant difference in IAP between patients with umbilical hernia and patients with no demonstrable hernias. Rise in IAP is caused by multiple factors. In our investigation, elevated IAP remained a risk factor for umbilical hernias even though BMI did not. Furthers studies must be done to find the etiology of increased IAP in patients with hernias so that we may aim to actively correct the etiology. Keywords: Intra abdominal pressure, obesity, umbilical hernia, Valsalva manoeuvre