Highlights
- •Primary sutured repair of umbilical hernia defects had a recurrence rate of 3.6% after 4.7 years.
- •Incisional umbilical hernias were 4.2 times more likely to recur compared to primary defects.
- •Suture choice, diabetes, BMI, tobacco use history, and wound complications did not predict hernia recurrence.
Abstract
Background
An evidence-based approach to the repair of umbilical hernias (UH)<1 cm has yet to
be defined.
Methods
A prospectively maintained, institutional hernia database was queried for patients
undergoing primary suture repair of UH ≤ 1 cm. The primary outcome was recurrence
and secondary outcomes were wound complications.
Results
Of 332 patients included (226-primary, 106-incisional), recurrence was identified
in 4 (1.8%) primary versus 8 (7.5%) incisional-UH (p = 0.022), with follow-up of 4.7 ± 4.4
years. There were 10 (3.0%) wound complications: 4 (1.2%) superficial wound infections,
1 (0.3%) superficial wound dehiscence, and 5 (1.5%) seromas. On multivariable analysis
of recurrence, incisional-UH had an odds ratio of 4.2 compared to primary. Suture
choice, diabetes, BMI, tobacco-use history, and wound complications were not significant.
Conclusions
With long term follow-up, recurrence after primary suture repair of UH ≤ 1 cm occurred
in 1.8% of primary and 7.5% of incisional UH. On multivariable analysis, incisional-UH
increased recurrence odds by 4.2 times compared to primary.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Frequency of abdominal wall hernias: is classical teaching out of date?.JRSM Short Rep. 2011; 2: 1-6https://doi.org/10.1258/SHORTS.2010.010071
- Epidemiologic, economic, and sociologic aspects of hernia surgery in the United States in the 1990s.Surg Clin. 1998; 78: 941-951https://doi.org/10.1016/S0039-6109(05)70363-7
- Ventral hernia management: expert consensus guided by systematic review.Ann Surg. 2017; 265: 80-89https://doi.org/10.1097/SLA.0000000000001701
- Guidelines for treatment of umbilical and epigastric hernias from the European hernia society and americas hernia society.Br J Surg. 2020; 107: 171-190https://doi.org/10.1002/BJS.11489
- Treatment of small (< 2 cm) umbilical hernias: guidelines and current trends from the Herniamed Registry.Hernia. 2021; 25: 605-617https://doi.org/10.1007/S10029-020-02345-W
- Classification of primary and incisional abdominal wall hernias.Hernia. 2009; 13: 407https://doi.org/10.1007/S10029-009-0518-X
- Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair.Hernia. 2005; 9: 334-337https://doi.org/10.1007/S10029-005-0010-1
- Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults.Br J Surg. 2001; 88: 1321-1323https://doi.org/10.1046/J.0007-1323.2001.01893.X
- [Long-term results after Spitzy's umbilical hernia repair].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2003; 74: 50-54https://doi.org/10.1007/S00104-002-0536-Z
- Umbilical hernia repair with the prolene hernia system.Am J Surg. 2005; 190: 61-64https://doi.org/10.1016/J.AMJSURG.2004.09.021
- Unacceptable results of the Mayo procedure for repair of abdominal incisional hernias.Eur J Surg. 1998; 164: 361-367https://doi.org/10.1080/110241598750004391
- Factors associated with long-term outcomes of umbilical hernia repair.JAMA Surgery. 2017; 152: 461-466https://doi.org/10.1001/JAMASURG.2016.5052
- Lower risk of recurrence after mesh repair versus non-mesh sutured repair in open umbilical hernia repair: a systematic review and meta-analysis of randomized controlled trials.Scand J Surg. 2019; 108: 187-193https://doi.org/10.1177/1457496918812208
- Suture versus mesh repair in primary and incisional ventral hernias: a systematic review and meta-analysis.World J Surg. 2016; 40: 826-835https://doi.org/10.1007/S00268-015-3311-2
- Outcomes of ventral hernia repair with concomitant panniculectomy.Ann Plast Surg. 2018; 80: 391-394https://doi.org/10.1097/SAP.0000000000001277
- Laparoscopic versus open surgical techniques for ventral or incisional hernia repair.Cochrane Database Syst Rev. 2011; 3 (.PUB2)https://doi.org/10.1002/14651858.CD007781
- Classification of primary and incisional abdominal wall hernias.Hernia. 2009; 13: 407https://doi.org/10.1007/S10029-009-0518-X
- Primary and incisional ventral hernias are different in terms of patient characteristics and postoperative complications - a prospective cohort study of 4,565 patients.Int J Surg. 2018; 51: 114-119https://doi.org/10.1016/J.IJSU.2018.01.010
- Laparoscopic repair of primary and incisional ventral hernias: the differences must be acknowledged - a prospective cohort analysis of 1,088 consecutive patients.Surg Endosc. 2014; 28: 891-895https://doi.org/10.1007/S00464-013-3243-6
- Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial.Lancet. 2018; 391: 860-869https://doi.org/10.1016/S0140-6736(18)30298-8
- SUMMER Trial: mesh versus suture repair in small umbilical hernias in adults-a study protocol for a prospective randomized double-blind multicenter clinical trial.Trials. 2021; 22https://doi.org/10.1186/S13063-021-05366-7
- Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study.Am J Surg. 2015; 209: 725-732https://doi.org/10.1016/J.AMJSURG.2014.05.021
- Umbilical hernia repair and recurrence: need for a clinical trial?.BMC Surg. 2021; 21https://doi.org/10.1186/S12893-021-01358-1
- Predictors for recurrence after open umbilical hernia repair in 979 patients.Surgery. 2019; 166: 615-622https://doi.org/10.1016/J.SURG.2019.04.040
- Predictors of recurrence of umbilical hernias following primary tissue repair in obese veterans.Am J Surg. 2016; 211: 18-23https://doi.org/10.1016/J.AMJSURG.2015.03.014
- Sutured repair of primary small umbilical and epigastric hernias: concomitant rectus diastasis is a significant risk factor for recurrence.World J Surg. 2014; 39 (2014;39(1)): 121-126https://doi.org/10.1007/S00268-014-2765-Y
- Shared and nonshared familial susceptibility to surgically treated inguinal hernia, femoral hernia, incisional hernia, epigastric hernia, and umbilical hernia.J Am Coll Surg. 2013; 217 (e1): 289-299https://doi.org/10.1016/J.JAMCOLLSURG.2013.04.020
- Antibiotic prophylaxis in umbilical and incisional hernia repair: a prospective randomised study.(March 23, 2022)
- EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances.BJS Open. 2020; 4: 342-353https://doi.org/10.1002/BJS5.50252
- Does closure of fascia, type, and location of trocar influence occurrence of port site hernias? A literature review.Surg Endosc. 2020; 34 (2020 34:12): 5250-5258https://doi.org/10.1007/S00464-020-07826-8
Article info
Publication history
Published online: September 23, 2022
Accepted:
September 13,
2022
Received:
July 29,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
