Identifying Effectors of Outcomes in Patients with Large Umbilical Hernias

Abstract

Quality of life (QOL) has become an important focus of hernia repair outcomes. This study aims to identify factors which lead to ideal outcomes (asymptomatic and without recurrence) in large umbilical hernias (defect size ≥9 cm2). Review of the prospective International Hernia Mesh Registry was performed. The Carolinas Comfort Scale was used to measure QOL at 1-, 6-, and 12-month follow-up. Demographics, operative details, complications, and QOL data were evaluated using standard statistical methods. Forty-four large umbilical hernia repairs were analyzed. Demographics included: average age 53.6 ± 12.0 and body mass index 34.9 ± 7.2 kg/m2. The mean defect size was 21.7 ± 16.9 cm2, and 72.7 per cent were performed laparoscopically. Complications included hematoma (2.3%), seroma (12.6%), and recurrence (9.1%). Follow-up and ideal outcomes were one month = 28.2 per cent, six months = 42.9 per cent, one year = 55.6 per cent. All patients who remained symptomatic at one and two years were significantly symptomatic before surgery. Symptomatic preoperative activity limitation was a significant predictor of nonideal outcomes at one year ( P = 0.02). Symptomatic preoperative pain was associated with nonideal outcomes at one year, though the difference was not statistically significant ( P = 0.06). Operative technique, mesh choice, and fixation technique did not impact recurrence or QOL. Repair of umbilical hernia with defects ≥9 cm2 had a surprising low rate of ideal outcomes (asymptomatic and no recurrence). All patients with nonideal long-term outcomes had preoperative pain and activity limitations. These data may suggest that umbilical hernia should be repaired when they are small and asymptomatic.

Influência de diferentes técnicas de reparo na recorrência de hérnias umbilicais: uma revisão sistemática / Influence of different repair techniques on the recurrence of umbilical hernias: a systematic review

“…18,19 Apesar da baixa taxa de recidivas, é importante lembrar que o uso laparoscópico deve ser considerado no caso de hérnias grandes e para hérnias recorrentes e incisionais. 20,21,22,23 Convém ressaltar também que é comum o desenvolvimento de hérnia umbilical em pacientes com cirrose, e a técnica mais apropriada é a hernioplastia de botão (Button Hole) com nenhuma recidiva nos 40 pacientes. 24 Não houve diferenças significativas nas taxas de recorrências entre os grupos com cirrose e sem cirrose no estudo cuja técnica foi o uso da tela polipropileno no plano pré-peritoneal.…”

Hernia umbilical: un problema no resuelto

“…• Una búsqueda de posibles factores condicionantes de resultados quirúrgicos ideales (ausencia de síntomas y baja recurrencia) en hernias umbilicales grandes encontró que los mismos son "sorprendentemente bajos" a pesar de la técnica y el uso de prótesis, resultando en dolor y limitación para la actividad diaria. Los autores proponen cirugía temprana en todos los defectos menores de 9 cm 2 e incluso en hernias asintomáticas (28) .…”