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 AB134. Umbilical hernia repair: the fenestrated linea alba—time for surgeons to take note

2020 ◽  
Vol 4 ◽  
pp. AB134-AB134
Author(s):  
Jennifer Mannion ◽  
Mohamed Khalid Hamed ◽  
Ritu Negi ◽  
Alison Johnston ◽  
Michael Sugrue
Keyword(s):  
Hernia Repair ◽  
Umbilical Hernia ◽  
Linea Alba ◽  
Umbilical Hernia Repair

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.

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 O47 MESH-RELATED COMPLICATIONS, CHRONIC PAIN, AND ECONOMIC CLAIM COMPENSATION AFTER UMBILICAL HERNIA REPAIR

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Martin Frimand Rønnow ◽  
Mattias Hoffner ◽  
Svend Schulze ◽  
Frederik Helgstrand ◽  
Claes Hjalmarsson ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Hernia Repair ◽  
Emergency Surgery ◽  
Mesh Repair ◽  
Umbilical Hernia ◽  
Surgical Complication ◽  
Claim Data ◽  
Wound Complications ◽  
Major Complications ◽  
Umbilical Hernia Repair

Abstract Aim The risk of mesh-related surgical complications after umbilical hernia repair is not known and chronic pain has only sparsely been analysed. Economic claims may represent a surrogate for poor postoperative surgical outcomes. Thus, the present study used mesh-related complications and chronic pain as primary and secondary outcomes, respectively. Material and Methods Blinded assessment of Swedish and Danish nationwide consecutive economic claim data from 2007 –2019. The study variables and outcomes were pre-study defined. Major complications were defined as acutely life-threatening complications requiring emergency surgery, clinically important complications were defined as all complications requiring surgical intervention but not emergency surgery. Results During the 13-years study period 181 patients were eligible for analysis. There were 96 patients with a surgical complication. In 52 (54%) and 44 (46%) patients the complication was mesh- or non-mesh-related, respectively. In the group of mesh- and non-mesh-related complications, major complications were found in 14 (14,6%) vs 21 (21,9%) patients and clinically important complications were found in 38 (39,5%) vs 23 (23,9%) patients respectively (P &lt; 0.05). Chronic pain was reported in 18%, followed by wound complications (14%) and cosmetic claim reasons (11%). After open repair, claim because of chronic pain was significantly more common after mesh repair (48%) compared with non-mesh repairs (32%), P = 0.05. The economic compensation after a mesh- and non-mesh complication was 3,488€ (291 – 188,186€) and 2,342€ (507€ - 58,437€) (P = 0.55), respectively. Conclusions Mesh-repair was related to postoperative complications and chronic pain after umbilical hernia repair

Importance of mesh overlap on hernia recurrence after open umbilical hernia repair with bilayer prosthesis

2018 ◽  
Vol 216 (5) ◽  
pp. 919-922 ◽  
Author(s):  
Jose L. Porrero ◽  
Oscar Cano-Valderrama ◽  
María J. Castillo ◽  
Alberto Marcos ◽  
Gabriel Tejerina ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Umbilical Hernia ◽  
Hernia Recurrence ◽  
Umbilical Hernia Repair

scholarly journals 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

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.

632 SUTURED VERSUS MESH-AUGMENTED HIATUS HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Josipa Petric ◽  
Tim Bright ◽  
David Liu ◽  
Melissa Wee ◽  
David Watson
Keyword(s):  
Systematic Review ◽  
Hiatus Hernia ◽  
Mesh Repair ◽  
Meta Analysis ◽  
Hernia Recurrence ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Absorbable Mesh ◽  
Hiatal Closure

Abstract   Repair of large hiatus hernias is increasingly being performed. However, there is no consensus for the optimal technique for hiatal closure between sutured versus mesh-augmented (absorbable or non-absorbable) repair. This meta-analysis systematically reviewed published randomized control trials (RCTs) comparing sutured versus mesh-augmented hiatus hernia (HH) repair. Our primary endpoint was HH recurrence at short- and long-term follow-up. Secondary endpoints were: surgical complications, operative times, dysphagia and quality of life. Methods A systematic review of Medline, Scopus (which encompassed Embase), Cochrane Central Register of Controlled Trials, Web of Science and PubMed was performed to identify relevant studies comparing mesh-augmented versus sutured HH repair. Data were extracted and compared by meta-analysis, using odds ratio and mean differences with 95% confidence intervals. Results Seven RCTs were found which compared mesh-augmented (non-absorbable mesh: n = 296; absorbable mesh: n = 92) with sutured repair (n = 347). There were no significant differences for short-term hernia recurrence (defined as 6–12 months, 10.1% mesh versus 15.5% sutured, P = 0.22), long-term hernia recurrence (defined as 3–5 years, 30.7% mesh vs 31.3% sutured, P = 0.69), functional outcomes and patient satisfaction. The only statistically significant difference was that the mesh repair required a longer operation time (P = 0.05, OR 2.33, 95% CI 0.03–24.69). Conclusion Mesh repair for hiatus hernia does not offer any advantage over sutured hiatal closure. As both techniques deliver good and comparable clinical outcomes, a suture only technique is still an appropriate approach.

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