Umbilical Hernia Repair: Analysis after 934 Procedures

There is a lack of consensus about the surgical management of umbilical hernias. The aim of this study is to analyze the medium-term results of 934 umbilical hernia repairs. In this study, 934 patients with an umbilical hernia underwent surgery between 2004 and 2010, 599 (64.1%) of which were evaluated at least one year after the surgery. Complications, recurrence, and the reoperation rate were analyzed. Complications were observed in 5.7 per cent of the patients. With a mean follow-up time of 35.5 months, recurrence and reoperation rates were 3.8 per cent and 4.7 per cent, respectively. A higher percentage of female patients (60.9 % vs 29 %, P = 0.001) and a longer follow-up time (47.4 vs 35 months, P = 0.037) were observed in patients who developed a recurrence. No significant differences were observed between complications and the reoperation rate in patients who underwent Ventralex® preperitoneal mesh reinforcement and suture repair; however, a trend toward a higher recurrence rate was observed in patients with suture repair (6.5 % vs 3.2 %, P = 0.082). Suture repair had lower recurrence and reoperation rates in patients with umbilical hernias less than 1 cm. Suture repair is an appropriate procedure for small umbilical hernias; however, for larger umbilical hernias, mesh reinforcement should be considered.

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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 ◽

10.1186/s13063-021-05366-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

M. Melkemichel ◽

S. Bringman ◽

G. Granåsen ◽

B. Widhe

Keyword(s):

Clinical Trial ◽

Hernia Repair ◽

Umbilical Hernia ◽

Suture Repair ◽

Large Sample Size ◽

Recurrence Rates ◽

Double Blind ◽

Umbilical Hernia Repair ◽

Onlay Mesh

Abstract Background Small umbilical hernia repair is one of the most common surgical performances in general surgery. Yet, a gold standard procedure for the repair is still lacking today. There is an increasing evidence that mesh could be advantageous compared to suture repair in lowering recurrence rates. An additional important question remains with regard to the optimal anatomical positioning of the mesh. We hypothesize that the use of an onlay mesh in small umbilical hernia defects can reduce recurrence rates without increasing the complications compared to a simple suture repair. Methods A prospective, national, multicenter, randomized, double-blind clinical trial comparing a standardized 4 × 4 cm onlay mesh to a conventional suture repair will be conducted. A total of 288 patients with a primary elective umbilical hernia ≤ 2 cm from 7 participating Swedish surgical centers will be enrolled. Intraoperative randomization will take place using a centralized web-based system resulting in total allocation concealment. Stratification will be done by surgical site and by defect size. Trial participants and follow-up clinical surgeons will be blinded to the assigned allocation. The primary outcome assessed will be postoperative recurrence at 1 and 3 years. Secondary outcomes assessed will be postoperative complications at 30 days and pain 1 year after surgery. Discussion Currently, there has been no randomized clinical trial comparing the recurrence rates between an onlay mesh repair and a simple suture repair for small umbilical hernia defects. How to best repair a small umbilical hernia continues to be debated. This trial design should allow for a good assessment of the differences in recurrence rate due to the large sample size and the adequate follow-up. Surgeons’ concerns surrounding optimal anatomical positioning and fear for larger required dissections are understandable. A small onlay mesh may become an easy and safe method of choice to reduce recurrence rates. Guidelines for small umbilical hernia repairs have stressed the need for reliable data to improve treatment recommendations. We can expect that this trial will have a direct implication on small umbilical hernia repair standards. Trial registration ClinicalTrials.gov NCT04231071. Registered on 31 January 2020. SUMMER Trial underwent external peer review as part of the funding process.

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Trocar umbilical hernia repair by open suture repair and open suture–mesh repair in an ambulatory setting in comparison to recurrent and primary umbilical hernia repair

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa270 ◽

2020 ◽

Vol 2020 (9) ◽

Author(s):

René G Holzheimer ◽

Nikolai Gaschütz

Keyword(s):

Hernia Repair ◽

Mesh Repair ◽

Umbilical Hernia ◽

Late Onset ◽

Recurrent Hernia ◽

Ambulatory Setting ◽

Suture Repair ◽

Umbilical Hernia Repair ◽

Trocar Hernia

Abstract Reports on the ambulatory open repair of umbilical trocal hernias are missing. Patients with trocar, primary and recurrent umbilical hernia open suture and open suture–mesh repair with prospective follow-up were retrospectively evaluated. Patients received perioperative antibiotic prophylaxis, preemptive analgesia and modified anesthesia. In total, 171 patients with umbilical hernia (51 years, female 14%; male 86%) were treated with open suture (n = 29; 17%) and suture–mesh (n = 142; 83%) repair. In total, 10% of patients were treated for trocar hernia (late onset), 5% for recurrent hernia and 85% for a primary umbilical hernia. In total, 29% of trocar hernia repairs had minor complications associated with obesity (40%) and comorbidity (80%). Age, suture and suture–mesh repair were not associated with complications. According to guidelines for umbilical hernia repair open flat mesh may be useful in the treatment of trocar hernia.

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P003 SUMMER TRIAL: MESH VERSUS SUTURE REPAIR IN SMALL UMBILICAL HERNIAS IN ADULTS: A STUDY PROTOCOL FOR A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, MULTICENTER CLINICAL TRIAL

British Journal of Surgery ◽

10.1093/bjs/znab395.002 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Maria Melkemichel ◽

Sven Bringman ◽

Gabriel Granåsen ◽

Björn Widhe

Keyword(s):

Clinical Trial ◽

Umbilical Hernia ◽

Standard Procedure ◽

Suture Repair ◽

Large Sample Size ◽

Recurrence Rates ◽

Double Blind ◽

Umbilical Hernia Repair ◽

Onlay Mesh

Abstract Aim A gold standard procedure for small umbilical hernia repairs is still lacking today. There is an increasing evidence that mesh could be advantageous in lowering recurrence rates. A question remains with regard to optimal anatomical positioning of the mesh. We hypothesize that the use of an onlay-mesh can reduce recurrence rates without increasing complications compared to a simple-suture repair. Material and Methods A prospective, national, multicenter, randomized, double-blind clinical trial comparing a standardized 4x4 cm onlay mesh to a conventional suture repair will be conducted. 288 patients with a primary elective umbilical hernia ≤ 2 cm from 7 participating Swedish surgical centers will be enrolled. Intraoperative randomization will take place. Trial participants and follow-up clinical surgeons will be blinded to the assigned allocation. The primary outcome assessed will be postoperative recurrence at 1 and 3 years. Secondary outcomes assessed will be postoperative complications at 30 days and pain 1 year after surgery. Results 140 participants are included since February 2020 and 95 participants are randomized. Conclusions How to best repair a small umbilical hernia continues to be debated. A small onlay-mesh may become an easy and a safe method of choice to reduce recurrence rates in small umbilical hernia defects. This trial design should allow for a good assessment of differences in recurrence rate with due to the large sample size and the adequate follow-up. Guidelines for small umbilical hernia repairs have stressed the need for reliable data to improve treatment recommendations. We can expect that this trial will have a direct implication on small umbilical hernia repair standards.

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Concomitant Osteotomy Reduces Risk of Reoperation Following Cartilage Restoration Procedures of the Knee: A Matched Cohort Analysis

Cartilage ◽

10.1177/19476035211011515 ◽

2021 ◽

pp. 194760352110115

Author(s):

Jacob G. Calcei ◽

Kunal Varshneya ◽

Kyle R. Sochacki ◽

Marc R. Safran ◽

Geoffrey D. Abrams ◽

...

Keyword(s):

Cohort Analysis ◽

Reoperation Rate ◽

Similar Rate ◽

Osteochondral Allograft ◽

Complication Rates ◽

Cartilage Restoration ◽

Chondrocyte Implantation ◽

The Cost ◽

Reoperation Rates

Objective The objective of this study is to compare the (1) reoperation rates, (2) 30-day complication rates, and (3) cost differences between patients undergoing isolated autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA) procedures alone versus patients with concomitant osteotomy. Study Design Retrospective cohort study, level III. Design Patients who underwent knee ACI (Current Procedural Terminology [CPT] 27412) or OCA (CPT 27415) with minimum 2-year follow-up were queried from a national insurance database. Resulting cohorts of patients that underwent ACI and OCA were then divided into patients who underwent isolated cartilage restoration procedure and patients who underwent concomitant osteotomy (CPT 27457, 27450, 27418). Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using ICD-9-CM codes. The cost per patient was calculated. Results A total of 1,113 patients (402 ACI, 67 ACI + osteotomy, 552 OCA, 92 OCA + osteotomy) were included (mean follow-up of 39.0 months). Reoperation rate was significantly higher after isolated ACI or OCA compared to ACI or OCA plus concomitant osteotomy (ACI 68.7% vs. ACI + osteotomy 23.9%; OCA 34.8% vs. OCA + osteotomy 16.3%). Overall complication rates were similar between isolated ACI (3.0%) and ACI + osteotomy (4.5%) groups and OCA (2.5%) and OCA + osteotomy (3.3%) groups. Payments were significantly higher in the osteotomy groups at day of surgery and 9 months compared to isolated ACI or OCA, but costs were similar by 2 years postoperatively. Conclusions Concomitant osteotomy at the time of index ACI or OCA procedure significantly reduces the risk of reoperation with a similar rate of complications and similar overall costs compared with isolated ACI or OCA.

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Umbilical hernia: Factors indicative of recurrence

Medicina ◽

10.3390/medicina44110108 ◽

2008 ◽

Vol 44 (11) ◽

pp. 855 ◽

Cited By ~ 31

Author(s):

Linas Venclauskas ◽

Jolita Šilanskaitė ◽

Mindaugas Kiudelis

Keyword(s):

Risk Factors ◽

Recurrence Rate ◽

Umbilical Hernia ◽

Hernia Recurrence ◽

Suture Repair ◽

Repair Technique ◽

Umbilical Hernia Repair ◽

Open Mesh Repair ◽

Onlay Technique ◽

Hernia Size

Umbilical hernia has gained little attention from surgeons in comparison with other types of abdominal wall hernias (inguinal, postoperative); however, the primary suture for umbilical hernia is associated with a recurrence rate of 19–54%. The aim of this study was to analyze the results of the umbilical hernia repair and to assess the independent risk factors influencing umbilical hernia recurrence. Materials and methods. A retrospective analysis of patients who underwent surgery for umbilical hernia in the Hospital of Kaunas University of Medicine in 2001–2006 was performed. Age, sex, hospital stay, hernia size, patient’s body mass index, and postoperative complications were analyzed. Postoperative evaluation included pain and discomfort in the abdomen and hernia recurrence rate. The questionnaire, which involved all these previously mentioned topics, was sent to all patients by mail. Hernia recurrence was diagnosed during the patients’ visit to a surgeon. Two surgical methods were used to repair umbilical hernia: open suture repair technique (keel technique) and open mesh repair technique (onlay technique). Every operation was chosen individually by a surgeon. Results. Ninety-seven patients (31 males and 66 females) with umbilical hernia were examined. The mean age of the patients was 57.1±15.4 years, hernia anamnesis – 7.6±8.6 years, hospital stay – 5.38±3.8 days. Ninety-two patients (94.8%) were operated on using open suture repair technique and 5 (5.2%) patients – open mesh repair technique. Only 7% of patients whose BMI was >30 kg/m2 and hernia size >2 cm and 4.3% of patients whose BMI was <30 kg/m2 and hernia size <2 cm were operated on using onlay technique (P>0.05). The rate of postoperative complications was 5.2%. Sixty-seven patients (69%) answered the questionnaire. The complete patient’s recovery time after surgery was 2.4±3.4 months. Fourteen patients (20.9%) complained of pain or discomfort in the abdomen, and 7 patients (10.4%) had ligature fistula after the surgery. Forty-five patients (67.2%) did not have any complaints after surgery. The recurrence rate after umbilical hernia repair was 8.9%. The recurrence rate was higher when hernia size was >2 cm (9% for <2 cm vs 10.5% for >2 cm) and patient’s BMI was >30 kg/m2 (8.6% for < 30 vs 10.7% for >30). There were 5 recurrence cases after open suture repair and one case after onlay technique. Fifty-six patients (83.6%) assessed their general condition after surgery as good, 9 patients (13.4%) as satisfactory, and only 2 patients (3%) as poor. Conclusions. We did not find any significant independent risk factors for umbilical hernia recurrence. However, based on reviewed literature, higher patient’s body mass index and hernia size of >2 cm could be the risk factors for umbilical hernia recurrence.

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Identifying Effectors of Outcomes in Patients with Large Umbilical Hernias

The American Surgeon ◽

10.1177/000313481608200727 ◽

2016 ◽

Vol 82 (7) ◽

pp. 613-621 ◽

Cited By ~ 3

Author(s):

Steven A. Groene ◽

Davis W. Heniford ◽

Tanushree Prasad ◽

Amy E. Lincourt ◽

Vedra A. Augenstein

Keyword(s):

Umbilical Hernia ◽

Defect Size ◽

Long Term Outcomes ◽

Preoperative Pain ◽

The Mean ◽

The Difference ◽

One Year

Quality of life (QOL) has become an important focus of hernia repair outcomes. This study aims to identify factors which lead to ideal outcomes (asymptomatic and without recurrence) in large umbilical hernias (defect size ≥9 cm2). Review of the prospective International Hernia Mesh Registry was performed. The Carolinas Comfort Scale was used to measure QOL at 1-, 6-, and 12-month follow-up. Demographics, operative details, complications, and QOL data were evaluated using standard statistical methods. Forty-four large umbilical hernia repairs were analyzed. Demographics included: average age 53.6 ± 12.0 and body mass index 34.9 ± 7.2 kg/m2. The mean defect size was 21.7 ± 16.9 cm2, and 72.7 per cent were performed laparoscopically. Complications included hematoma (2.3%), seroma (12.6%), and recurrence (9.1%). Follow-up and ideal outcomes were one month = 28.2 per cent, six months = 42.9 per cent, one year = 55.6 per cent. All patients who remained symptomatic at one and two years were significantly symptomatic before surgery. Symptomatic preoperative activity limitation was a significant predictor of nonideal outcomes at one year ( P = 0.02). Symptomatic preoperative pain was associated with nonideal outcomes at one year, though the difference was not statistically significant ( P = 0.06). Operative technique, mesh choice, and fixation technique did not impact recurrence or QOL. Repair of umbilical hernia with defects ≥9 cm2 had a surprising low rate of ideal outcomes (asymptomatic and no recurrence). All patients with nonideal long-term outcomes had preoperative pain and activity limitations. These data may suggest that umbilical hernia should be repaired when they are small and asymptomatic.

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Long-term follow-up after elective adult umbilical hernia repair: low recurrence rates also after non-mesh repairs

Hernia ◽

10.1007/s10029-012-0988-0 ◽

2012 ◽

Vol 17 (4) ◽

pp. 493-497 ◽

Cited By ~ 25

Author(s):

J. Dalenbäck ◽

C. Andersson ◽

D. Ribokas ◽

G. Rimbäck

Keyword(s):

Hernia Repair ◽

Umbilical Hernia ◽

Recurrence Rates ◽

Umbilical Hernia Repair ◽

Long Term Follow Up

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Psychosomatic Inpatient Treatment Achieves in the Medium Term Sustainable Clinical Improvement as well as a Reduction in Utilization of Medical Services-Results of a one-year follow-up

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1495 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s784-s784

Author(s):

J. Valdes-Stauber ◽

S. Merath ◽

S. Krämer

Keyword(s):

Drop Out ◽

Medical Services ◽

Medium Term ◽

Post Discharge ◽

Doctor Visits ◽

Drop Out Rate ◽

One Year ◽

Hospital Days

BackgroundThe research on sustainability of effectiveness of inpatient psychosomatic treatment is necessary for epidemiological and economic reasons as well as towards their legitimacy.Objectives and aimsTo investigate whether the achieved clinical improvement by the inpatient treatment continues one year after discharge and whether the utilization of medical services display a significant reduction post-discharge compared to the year before admission.MethodsNaturalistic 1 year follow-up study of a cohort (n = 122). Three measuring time points: T1 (discharge), T2 (6 months after discharge; drop-out rate about 33%), T3 (12 months after discharge; drop-out rate about 49%). Assessment by means of standardized tests of changes in clinical variables, self-efficacy, quality of life, and personality between discharge and one year after discharge. Utilization variables (hospital days, days of incapacity, medication and doctor visits) were compared with ranges in the year before admission.ResultsImprovements at discharge in general functionality, psychological and somatic stress, depressiveness, bitterness level, quality of life and self-efficacy remain one year after discharge sustainably. Furthermore, hospital days, days of incapacity, number of doctor visits and of prescribed drugs decreased significantly in comparison with the year prior to admission.ConclusionsInpatient psychotherapy is effective not only in short-term but also in medium-term. One year after discharge clinically improvement at discharge time-point remains stable and the utilization of medical services decreased significantly. Longer periods of observation, identification of risk groups and of resilient prognostic factors, as well as ensuring post-discharge care are necessary in order to prevent relapses and to made early interventions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Umbilical Herniorrhaphy Reinforced with Biologic Mesh

The American Surgeon ◽

10.1177/000313481007601118 ◽

2010 ◽

Vol 76 (11) ◽

pp. 1205-1209

Author(s):

David S. Edelman ◽

Charles F. Bellows

Keyword(s):

Extracellular Matrix ◽

Patient Satisfaction ◽

Umbilical Hernia ◽

Enterocutaneous Fistula ◽

Synthetic Mesh ◽

Biologic Mesh ◽

Preliminary Evaluation ◽

Umbilical Hernia Repair ◽

Preliminary Study

The true recurrence rate after umbilical hernia repair in not known. After simple closure, the reported rate of recurrence in the literature is as high as 54 per cent. With synthetic mesh repair, the recurrence rates are lowered to less than 10 per cent. However, synthetic mesh is associated with complications such as enterocutaneous fistula and mesh infections. This preliminary study looks at the safety and effectiveness of biologic extracellular matrix mesh reinforcement in the repair of umbilical hernias. We retrospectively reviewed all patients who underwent repair of an umbilical hernia defect (2-3 cm) with primary approximation of the margins and reinforced using a biologic mesh placed beneath the umbilical fascia from 2007 to 2009. Demographic data were collected. Patients were followed prospectively at 2 weeks, 8 weeks, 6 months, and 1 year. Data were reviewed for postoperative complications, hernia recurrence, and patient satisfaction. During the study period, 16 patients completed the 1 year follow-up. There were 10 men and six women. Ages ranged from 28 to 75 years with a mean age of 47.6 years. The hernias were 2 to 3 cm in size. Complications were minimal. Overall patient satisfaction with the procedure was high. There were no mesh infections. During a mean follow-up of 12 months, only one patient had recurrent hernia (6%). This preliminary evaluation shows promise for an alternative treatment of umbilical hernias using biologic extracellular matrix mesh added as an underlay to reinforce a primary closure. The biologic mesh has a low incidence of infection and complications and results in high patient satisfaction. This preliminary study begs for a randomized, prospective evaluation with long-term follow-up.

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