Umbilical hernia: Factors indicative of recurrence

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.

Download Full-text

Factors Indicative of Recurrence Paraumbilical Hernia: Experience at a Tertiary Care Hospital in Dhaka City

Journal of Current and Advance Medical Research ◽

10.3329/jcamr.v5i1.36539 ◽

2018 ◽

Vol 5 (1) ◽

pp. 11-14

Author(s):

Mohammad Ibrahim Khalil ◽

Haridas Saha ◽

Aminul Islam ◽

Abdullah Al Mamun ◽

AZM Mostaque Hossain ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Hernia Repair ◽

Recurrence Rate ◽

Hernia Recurrence ◽

Care Hospital ◽

Paraumbilical Hernia ◽

Repair Technique ◽

Independent Risk Factors ◽

Hernia Size

Background: Paraumbilical hernia has gained little attention from surgeons in comparison with other types of abdominal wall hernias (inguinal, postoperative); however, the primary suture for paraumbilical hernia is associated with a recurrence rate of 19.0 to 54.0%.Objective: The aim of this study was to analyze the results of the paraumbilical hernia repair and to assess the independent risk factors influencing paraumbilical hernia recurrence.Methodology: A retrospective analysis of patients who underwent surgery for paraumbilical hernia in the department of surgery, Dhaka Medical College Hospital from 2012 to 2015 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. Hernia recurrence was diagnosed during the patients’ visit to a surgeon. Two surgical methods were used to repair paraumbilical hernia: open suture repair technique (keel technique) and open mesh repair technique (onlay technique). Every operation was chosen individually by the surgeon.Results: Ninety-seven patients (31 males and 66 females) with paraumbilical hernia were examined. The rate of postoperative complications was 5.2%. 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(10.4%) patients had ligature fistula after the surgery. Forty-five patients (67.2%) did not have any complaints after surgery. The recurrence rate after paraumbilical hernia repair was 8.9%. The recurrence rate was higher when hernia size was >2cm (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).Conclusion: In conclusion significant independent risk factors are found for paraumbilical hernia recurrence.Journal of Current and Advance Medical Research 2018;5(1):11-14

Download Full-text

Long-term results of incisional hernia treatment

Medicina ◽

10.3390/medicina43110110 ◽

2007 ◽

Vol 43 (11) ◽

pp. 855 ◽

Cited By ~ 10

Author(s):

Linas Venclauskas ◽

Jolita Šilanskaitė ◽

Jurga Kanišauskaitė ◽

Mindaugas Kiudelis

Keyword(s):

Physical Activity ◽

Incisional Hernia ◽

Mesh Repair ◽

Study Groups ◽

Hernia Recurrence ◽

Suture Repair ◽

Open Mesh Repair ◽

Onlay Technique ◽

Open Mesh

Ventral hernia is a common problem in general surgery practice. Incisional hernia can develop in 15–25% of patients after abdominal surgery. The aim of this study was to compare two different methods of incisional hernia surgery. Materials and methods. A retrospective analysis of database of surgery department from 1997 to 2000 was performed. All patients were divided into two groups. The first group patients were operated using open suture repair (keel technique); the second group patients – using open mesh repair (onlay technique). Long-term follow-up was done by a mail questionnaire. A special questionnaire was sent to all patients. Postoperative evaluation included pain and discomfort in the abdomen, physical activity, and recurrence rate after operation. Statistical evaluation was conduced using descriptive analysis: the unpaired Student t test to compare parametric criterions between two study groups, Mann-Whitney U test to compare the unpaired nonparametric criterions between two study groups, and X2 test to investigate nonparametric criterions between these groups. Results. A total of 202 patients (51 males, 151 females) with incisional hernia were operated during 1997–2000. One hundred seventy-one patients were in the keel technique group, and 31 patients in the onlay technique group. There were no significantly differences in age and sex between these groups. The hospitalization time was significantly longer in the open mesh repair group. The postoperative complication (wound seroma and suppuration) rate was significantly higher in the onlay technique group. One hundred sixty-one patients (79.7%) answered the questionnaire (133 in the keel technique group, 28 the in onlay technique group). The patients’ return to physical activity after surgery was significantly longer in the keel technique group. Forty-one patients (31%) had hernia recurrence in the keel technique group and 3 patients (11%) in the onlay technique group (P<0.05). There were no postoperative deaths in both groups. Conclusions. The rates of postoperative therapeutic complications and hernia recurrence are significantly lower after open mesh repair surgery. Return to normal physical activity after surgery is significantly longer after open suture repair surgery.

Download Full-text

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.

Download Full-text

Variations in Nationwide Readmission Patterns after Umbilical Hernia Repair

The American Surgeon ◽

10.1177/000313481908500526 ◽

2019 ◽

Vol 85 (5) ◽

pp. 494-500 ◽

Cited By ~ 1

Author(s):

Sarah A. Eidelson ◽

Joshua Parreco ◽

Michelle B. Mulder ◽

Arjuna Dharmaraja ◽

L. Renee Hilton ◽

...

Keyword(s):

Risk Factors ◽

Hernia Repair ◽

Umbilical Hernia ◽

Skilled Nursing Facility ◽

Median Cost ◽

Nursing Facility ◽

Skilled Nursing ◽

For Profit ◽

Umbilical Hernia Repair ◽

Comorbidity Index

Up to one in three readmissions occur at a different hospital and are thus missed by current quality metrics. There are no national studies examining 30-day readmission, including to different hospitals, after umbilical hernia repair (UHR). We tested the hypothesis that a large proportion were readmitted to a different hospital, that risk factors for readmission to a different hospital are unique, and that readmission costs differed between the index and different hospitals. The 2013 to 2014 Nationwide Readmissions Database was queried for patients admitted for UHR, and cost was calculated. Multivariate logistic regression identified risk factors for 30-day readmission at index and different hospitals. There were 102,650 admissions for UHR and 8.9 per cent readmissions, of which 15.8 per cent readmissions were to a different hospital. The most common reason for readmission was infection (25.8%). Risk factors for 30-day readmission to any hospital include bowel resection, index admission at a for-profit hospital, Medicare, Medicaid, and Charlson Comorbidity Index ≥ 2. Risk factors for 30-day readmission to a different hospital include elective operation, drug abuse, discharge to a skilled nursing facility, and leaving against medical advice. The median cost of initial admission was higher in those who were readmitted ($16,560 [$10,805–$29,014] vs $11,752 [$8151–$17,724], P < 0.01). The median cost of readmission was also higher among those readmitted to a different hospital ($9826 [$5497–$19,139] vs $9227 [$5211–$16,817], P = 0.02). After UHR, one in six readmissions occur at a different hospital, have unique risk factors, and are costlier. Current hospital benchmarks fail to capture this sub-population and, therefore, likely underestimate UHR readmissions.

Download Full-text

Umbilical Hernia Repair: Analysis after 934 Procedures

The American Surgeon ◽

10.1177/000313481508100925 ◽

2015 ◽

Vol 81 (9) ◽

pp. 899-903 ◽

Cited By ~ 5

Author(s):

Jose L. Porrero ◽

Oscar Cano-Valderrama ◽

Alberto Marcos ◽

Oscar Bonachia ◽

Beatriz Ramos ◽

...

Keyword(s):

Umbilical Hernia ◽

Reoperation Rate ◽

Suture Repair ◽

Surgery Complications ◽

Medium Term ◽

Mesh Reinforcement ◽

Umbilical Hernia Repair ◽

One Year ◽

Reoperation Rates

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.

Download Full-text

Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair

Hernia ◽

10.1007/s10029-005-0010-1 ◽

2005 ◽

Vol 9 (4) ◽

pp. 334-337 ◽

Cited By ~ 62

Author(s):

J. A. Halm ◽

J. Heisterkamp ◽

H. F. Veen ◽

W. F. Weidema

Keyword(s):

Risk Factors ◽

Hernia Repair ◽

Mesh Repair ◽

Umbilical Hernia ◽

Umbilical Hernia Repair ◽

Long Term Follow Up ◽

Risk Factors For Recurrence

Download Full-text

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

The American Surgeon ◽

10.1177/0003134820951452 ◽

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.

Download Full-text

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.

Download Full-text

Techniques of Concomitant Abdominoplasty and Umbilical Hernia Repair: A Review

Aesthetic Surgery Journal ◽

10.1093/asj/sjab094 ◽

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.

Download Full-text

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

BMC Surgery ◽

10.1186/s12893-021-01358-1 ◽

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.

Download Full-text