Hernia Size and Mesh Placement in Primary Umbilical Hernia Repair

Abstract

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.

Giant umbilical hernia case report and literature review

“…Currently there is no consensus on the abdominal abdominoplasty techniques associated with umbilical defect repair and more prospective studies are needed to support the use of these techniques as well as the risk of complications associated with them. 6 The most frequent complications reported in large centers include seroma, hematoma and other complications such as urinary retention, ileus, site discomfort or pain without infection as well as hospitalization related to patient comorbidity. 6 Studies in specialized hernia centers with comorbid patients showed that the main risk factor for recurrence is the size of the defect, being greater in those larger than 4 cm.…”

“…6 The most frequent complications reported in large centers include seroma, hematoma and other complications such as urinary retention, ileus, site discomfort or pain without infection as well as hospitalization related to patient comorbidity. 6 Studies in specialized hernia centers with comorbid patients showed that the main risk factor for recurrence is the size of the defect, being greater in those larger than 4 cm. 6…”

“…6 Studies in specialized hernia centers with comorbid patients showed that the main risk factor for recurrence is the size of the defect, being greater in those larger than 4 cm. 6…”

Simultaneous Operations During Umbilical and Paraumbilical Hernia Repair: Possible or Necessary?

“…First of all, it should be noted that due to the high incidence of complications and recurrences the conventional open suturing technique with tissue materials is not the best choice. Although some authors believe that the choice between alloplasty and autografting is often based on the size of hernia: if the size of hernia gate is less than 2.0 cm (and in the opinion of Z.Tao et al [16] less than 2.3 cm), autografting can be a possible choice, and if said size is larger, mesh graft alloplasty should be used. But we believe that in addition to this factor it is necessary to take into consideration the thickening of the abdominal wall, which is observed in obese patients.…”

Letter re: Elective Hernia Repair in Obese Patients

“…2 Similarly, some sources suggest the use of a 2.0 cm hernia size for mesh placement in all UHs to prevent recurrence. 2 In reviewing the literature, these numbers are based on small heterogenous studies and lack of level I evidence is the rule. 2 In patients with a BMI of ≥40.0 Kg/m 2 , it is unrealistic to expect that most will lose significant weight to place them on the elective category for UH repair (short of undergoing weight reduction surgery).…”