Feasibility of Umbilical Hernia Repair Under Local Anesthesia and Monitored Anesthesia Care at a Veteran Affairs Hospital

Background Local anesthesia (LA) for open umbilical hernia tissue repair (OUHTR) is not widely utilized in academic centers in the United States. We hypothesize that LA for OUHTR is feasible in a veteran patient population. Methods From 2015 to 2019, 449 umbilical hernias were repaired at our institution utilizing a standardized technique in veteran patients. OUHTR was included in this analysis (n = 283). Since 2017, 18.7% (n = 53) UH were repaired under LA. We compared outcomes and operative times between general anesthesia and LA in patients undergoing OUHTR. Univariable and multivariable analyses were performed to determine significance. Results The entire cohort was composed of older (56.3 ± 12.1 years), White (75.5%), obese (body mass index [BMI] = 32.3 ± 4.6 kg/m2) men (98.0%). The average hernia size for the entire cohort was 2.42 ± 1.2 cm. The groups were similar in age and BMI. Patients with higher American Society of Anesthesiologists (ASA) (Odds ratio [OR] 3.1; 95% CI 1.5-6.8) and cardiovascular disease (OR 2.7; 95% CI 1.0-7.2) were more likely to receive LA. Recurrence (0.0% vs 6.0%; P = .9) and 30-day complications (6.0% vs 13%; P = .9) were similar between LA and GA after correcting for hernia size. Operating room times were reduced in the LA group (17.7 minutes; P < .05). None of the patients with LA required postanesthesia care unit for recovery. The patients who received LA reported being comfortable (78.9% of patients), with the worst reported pain being 2.4 ± 2.4 (out of a scale of 10), and 94.7% would elect to receive LA if they had another hernia repair. Conclusion Patients who received LA had more cardiac disease and a higher ASA. Complications were similar between both groups. LA reduced operating room times. Patients were satisfied with LA.

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Hernia Size and Mesh Placement in Primary Umbilical Hernia Repair

The American Surgeon ◽

10.1177/0003134820971624 ◽

2020 ◽

pp. 000313482097162

Author(s):

Zoe Tao ◽

Javier Ordonez ◽

Sergio Huerta

Keyword(s):

Systematic Review ◽

Hernia Repair ◽

Tissue Repair ◽

Umbilical Hernia ◽

Multivariable Analysis ◽

Review Of The Literature ◽

Mesh Placement ◽

Institutional Review ◽

Umbilical Hernia Repair ◽

Hernia Size

Introduction Umbilical hernia repair (UHR) using mesh has been demonstrated to significantly reduce recurrence. However, many surgical centers still perform tissue repair for UH. In the present study, we assessed a cohort of veteran patients undergoing a standard open tissue repair for primary UH to determine at which size recurrence may preclude tissue repair. A systematic review of the literature on hernia size recommendations to guide mesh placement was performed. Methods A single-institution single-surgeon retrospective review of all patients undergoing open tissue repair of primary UH (n = 344) was undertaken at the VA North Texas Health Care System between 2005 and 2019. Guidelines for the preferred reporting items for systematic reviews and meta-analysis were undertaken for systematic review. Results A literature review yielded inconsistent guidance for a specific hernia size to proceed with tissue vs. mesh repair. Our institutional review yielded 17 (4.9%) recurrences. Univariable analysis demonstrated recurrence to be associated with hernia size (2.8 vs. 2.3 cm; P = .04). However, on multivariable analysis, hernia size was demonstrated as not an independent predictor of recurrence [OR 1.47 (95% CI; .97-2.21; P = .07)]. Conclusion A review of the literature suggests mesh placement most commonly when the hernia size is > 2.0 cm; however, sources of evidence are heterogeneous in study design, patient population, and hernia types studied. Our institutional review demonstrated that primary UHs < 2.3 cm can successfully be treated via tissue repair. Larger, recurrent, incisional, and primary epigastric hernias may benefit from mesh placement.

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Local Anesthesia is Associated with Fewer Complications in Umbilical Hernia Repair in Frail Veterans

Journal of Surgical Research ◽

10.1016/j.jss.2021.04.006 ◽

2021 ◽

Vol 266 ◽

pp. 88-95

Author(s):

Jennie Meier ◽

Miles Berger ◽

Timothy P. Hogan ◽

Joan Reisch ◽

C. Munro Cullum ◽

...

Keyword(s):

Hernia Repair ◽

Local Anesthesia ◽

Umbilical Hernia ◽

Umbilical Hernia Repair

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Current practice patterns for initial umbilical hernia repair in the United States

Hernia ◽

10.1007/s10029-020-02164-z ◽

2020 ◽

Cited By ~ 3

Author(s):

S. Koebe ◽

J. Greenberg ◽

L.-C. Huang ◽

S. Phillips ◽

A. Lidor ◽

...

Keyword(s):

United States ◽

Hernia Repair ◽

Umbilical Hernia ◽

Current Practice ◽

Practice Patterns ◽

The United States ◽

Umbilical Hernia Repair

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Local Anesthesia Can Reduce Complications in Adults Undergoing Umbilical Hernia Repair

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.190 ◽

2020 ◽

Vol 231 (4) ◽

pp. S100-S101

Author(s):

Jennie Meier ◽

Miles Berger ◽

Munro Cullum ◽

Simon C. Lee ◽

Herbert J. Zeh ◽

...

Keyword(s):

Hernia Repair ◽

Local Anesthesia ◽

Umbilical Hernia ◽

Umbilical Hernia Repair

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Umbilical Hernia Repair

Operative Dictations in Pediatric Surgery ◽

10.1007/978-3-030-24212-1_67 ◽

2019 ◽

pp. 279-281

Author(s):

Katherine Culbreath ◽

Daniel Rhee

Keyword(s):

Hernia Repair ◽

Umbilical Hernia ◽

Umbilical Hernia Repair

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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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