Hernia Size and Mesh Placement in Primary Umbilical Hernia Repair

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.

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

2021 ◽  
pp. 000313482095145
Author(s):  
Lindsey Loss ◽  
Jennie Meier ◽  
Tri Phung ◽  
Javier Ordonez ◽  
Sergio Huerta
Keyword(s):  
Hernia Repair ◽  
Operating Room ◽  
Local Anesthesia ◽  
Umbilical Hernia ◽  
The United States ◽  
Postanesthesia Care Unit ◽  
Entire Cohort ◽  
Umbilical Hernia Repair ◽  
Hernia Size ◽  
To Receive

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.

Outcomes of Laparoscopic-Assisted, Open Umbilical Hernia Repair

2020 ◽  
Vol 86 (8) ◽  
pp. 1001-1004
Author(s):  
Jenny M. Shao ◽  
Sharbel A. Elhage ◽  
Tanu Prasad ◽  
Paul D. Colavita ◽  
Vedra A. Augenstein ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Umbilical Hernia ◽  
Patient Characteristics ◽  
Radiographic Examination ◽  
Intraperitoneal Onlay Mesh ◽  
Institutional Review ◽  
Umbilical Hernia Repair ◽  
Onlay Mesh ◽  
Laparoscopic Assisted

Umbilical hernia repair (UHR) is one of the most commonly performed hernia operations with reported recurrence rate from 1% to 54%. Our aim was to describe an open, laparoscopic-assisted (OLA) technique and its outcome in an institutional review board-approved prospective study at a tertiary hernia center from 2008 to 2019. All patients underwent a standard periumbilical incision, open dissection of the hernia, and closure of the fascial defect with laparoscopic intraperitoneal onlay mesh (IPOM) fixation with permanent tacks. A total of 186 patients were identified who underwent an OLA UHR repair. Patient characteristics are as follows: average age 52.8 ± 12.5 years, male gender 79.6%, body mass index 31.4 ± 8.0 kg/m2, and average hernia defect size of 2.8 ± 4.8 cm2. Forty-one (22.0%) patients had previous failed repair. Sixty-nine (37.1%) patients had another procedure performed at the time of the UHR, most commonly a laparoscopic transabdominal inguinal hernia repair (58%). The mean operative time was 87.3 ± 51.2 minutes, but only 63.9 ± 31.9 minutes for patients undergoing an OLA repair. There were no recurrences (0%) on abdominal physical or radiographic examination with an average follow-up of 16.5 ± 17.7 months. Postoperative complications included wound erythema (2.7%), hematomas (1.1%), seromas (2.7%), and 4.3% received postoperative oral antibiotics. One person was readmitted for seroma drainage, and another required reoperation for small bowel obstruction unrelated to the hernia repair. One patient had chronic pain requiring tack removal. With moderate follow-up, an OLA UHR with mesh appears to be a durable repair with favorable results, including those patients with recurrent hernias.

Techniques of Concomitant Abdominoplasty and Umbilical Hernia Repair: A Review

2021 ◽  
Author(s):  
Helene Person ◽  
Ali Mojallal ◽  
Fabienne Braye ◽  
Hristo Shipkov
Keyword(s):  
Hernia Repair ◽  
Umbilical Hernia ◽  
Laparoscopic Approach ◽  
Suture Technique ◽  
Hernia Recurrence ◽  
Open Approach ◽  
Mesh Infection ◽  
Infection Rates ◽  
Mesh Placement ◽  
Umbilical Hernia Repair

Abstract Background Different methods of simultaneous full abdominoplasty and umbilical hernia repair were proposed. Objectives To review We reviewed them and compared the results concerning the umbilical hernia repair outcomes and umbilical stalk survival. Methods A literature research was performed until 28 December 2019. Other hernia repair and mini-abdominoplasty (without umbilical transposition) were excluded. The primary outcomes analysed were umbilical hernia recurrence, mesh infection, and umbilical necrosis rates. Results Six studies were included (5 retrospectives series, 1 case report). Hernia was repaired by an open approach (3 studies, 28 patients) or a laparoscopic approach (3 studies, 67 patients). Umbilical hernia repair consisted in mesh placement in intraperitoneal or retromuscular/preperitoneal plane, or suture technique in intraperitoneal plane. None hernia recurrence, mesh infection, or umbilical necrosis were described. Conclusions Both open and laparoscopic approaches of simultaneous abdominoplasty and umbilical hernia repair seem to be safe regarding the umbilical stalk vascularisation, hernia recurrence and mesh infection rates. However, more well-designed studies are needed to prove this hypothesis.

scholarly journals Umbilical hernia repair and recurrence: need for a clinical trial?

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jennifer Mannion ◽  
Mohamed Khalid Hamed ◽  
Ritu Negi ◽  
Alison Johnston ◽  
Magda Bucholc ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hernia Repair ◽  
Mesh Repair ◽  
Umbilical Hernia ◽  
Hernia Recurrence ◽  
Cochrane Library ◽  
Large Defect ◽  
Linea Alba ◽  
Multiple Defects ◽  
Umbilical Hernia Repair

Abstract 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. Many factors are recognized contributors to recurrence however multiple defects in the linea alba, known to occur in up to 30% of patients, appear to have been overlooked by surgeons. Aims This systematic review assessed reporting of second or multiple linea alba defects in patients undergoing umbilical hernia repair to establish if these anatomical variations could contribute to recurrence along with other potential factors. Methods A systematic review of all published English language articles was undertaken using databases PubMed, Embase, Web of Science and Cochrane Library from January 2014 to 2019. The search terms ‘Umbilical hernia’ AND ‘repair’ AND ‘recurrence’ were used across all databases. Analysis was specified in advance to avoid selection bias, was registered with PROSPERO (154173) and adhered to PRISMA statement. Results Six hundred and forty-six initial papers were refined to 10 following article review and grading. The presence of multiple linea alba defects as a contributor to recurrence was not reported in the literature. One paper mentioned the exclusion of six participants from their study due multiple defects. In all 11 factors were significantly associated with umbilical hernia recurrence. These included: large defect, primary closure without mesh, high BMI in 5/10 publications; smoking, diabetes mellitus, surgical site Infection (SSI) and concurrent hernia in 3/10. In addition, the type of mesh, advanced age, liver disease and non-closure of the defect were identified in individual papers. Conclusion This study identified many factors already known to contribute to umbilical hernia recurrence in adults, but the existence of multiple defects in the linea, despite it prevalence, has evaded investigators. Surgeons need to be consider documentation of this potential confounder which may contribute to recurrence.

scholarly journals 1225 How Are Acutely Symptomatic Hernias Repaired in The UK? Surgical Techniques from The MASH Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Spence ◽  
◽  
Keyword(s):  
Hernia Repair ◽  
Umbilical Hernia ◽  
Surgical Techniques ◽  
Antibiotic Use ◽  
General Anaesthetic ◽  
Emergency Setting ◽  
Mesh Placement ◽  
Stoma Formation ◽  
Umbilical Hernia Repair ◽  
The Uk

Abstract Aim Minimal evidence exists guiding the emergency management of acutely symptomatic abdominal wall and groin hernias (ASH) and there is a lack of consensus on optimal surgical technique. The aim of this study was to explore surgical techniques used in the repair of ASH. Method A prospective 12-week cohort study (NCT04197271) recruited adult patients with ASH across 23 UK sites. Baseline characteristics, quality of life, management strategy and 30/90-day outcomes were collected. For those undergoing surgery, detailed information was recorded on: time to surgery, anaesthetic technique, grade of surgeon, intraoperative findings, antibiotic use, operative approach, repair technique (mesh vs suture), mesh/suture type and position, and whether bowel resection/stoma formation was required. Results Of the 264 patients recruited, 214 (82%) underwent acute repair within 48 hours of admission. 95% of patients underwent open repair, 93% under general anaesthetic. Mesh was used in 89% of inguinal hernia repair vs 29% umbilical hernia repair. The majority (86%) used a synthetic non-absorbable mesh (94% inguinal, 84% umbilical). Mesh placement varied widely for epigastric and umbilical hernia, with onlay used most commonly (24%). Similar variation was seen in suture choice. 8% of patients developed an SSI by 30 days, the majority which were in umbilical repairs. One patient developed early hernia recurrence (umbilical) requiring surgery. Conclusions This data demonstrates variation in the surgical management of ASH, especially with the use of mesh. Laparoscopic surgery was uncommon. Further studies are required to clarify optimal technique strategies in the emergency setting.

Umbilical Hernia Repair

2019 ◽  
pp. 279-281
Author(s):  
Katherine Culbreath ◽  
Daniel Rhee
Keyword(s):  
Hernia Repair ◽  
Umbilical Hernia ◽  
Umbilical Hernia Repair
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