The power of level-1 evidence in umbilical hernia repair: mesh repair is supported by strong evidence

Kaufmann, R.; Halm, Jens A.; Lange, Johan F.

doi:10.1007/s10029-020-02185-8

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…While the strength of evidence is high in favor of mesh over tissue repair for the management of UH to reduce recurrence, 18,27,28,32,33 multiple centers (including ours) still perform high numbers of tissue repair for primary UH. [5][6][7][8]10,[15][16][17] Tissue repair for UH has several advantages: (1) decreased risk of SSI, 34 (2) decreased risk of mesh migration, 13 (3) reduced operative times, and (4) performance more readily under LA.…”

Section: Discussionmentioning

confidence: 92%

Hernia Size and Mesh Placement in Primary Umbilical Hernia Repair

Tao

Ordonez

Huerta

2020

The American Surgeon

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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.

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Section: Discussionmentioning

confidence: 92%

Hernia Size and Mesh Placement in Primary Umbilical Hernia Repair

Tao

Ordonez

Huerta

2020

The American Surgeon

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Current issues of diagnosis and treatment of neonatal omphalocele

Щукина¹,

Mokrushina²,

Гурская³

et al. 2020

RPJ

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The review of topical issues of diagnostics and treatment of malformation of the anterior abdominal wall - omphalocele in newborns is presented. Currently, there are no specific, recognized criteria acceptable for the maintaining and further managing pregnancy, delivery and treatment of children with omphalocele. Prenatally, the possibility of predicting the tactics of surgical treatment and postoperative management of a newborn with omphalocele is not taken into account. In the choice of tactics of treatment of this category of patients there is a need to consider many factors, namely: the data for the antenatal diagnosis of the defect, duration of respiratory support at the stage of preparation for surgery, age at the time of surgical treatment, the size of the hernia SAC, and the size of the liver in the hernia SAC. These criteria are necessary to determine the possibility of radical surgery for the anterior abdominal wall or stage-by-stage treatment with the creation of a temporary abdominal cavity, with preliminary gradual immersion of the evented organs into the abdominal cavity under the control of the child’s hemodynamic and respiratory parameters, with the dynamic control of the occurrence and progression of pulmonary hypertension under the ultrasound control. To date, a unified approach has not been developed in the surgical treatment and postoperative care of newborns with omphalocele. The use of a variety of methods of surgical correction and their modifications reveals extensive potential for the treatment of different form of exomphalos, but leads to the fact that some of these techniques find their applications in a single universally accepted treatment of this condition. The lack of unified standards of prevention and organization of treatment approaches for newborns with various forms of omphalocele makes this problem very relevant. When preparing a literary review, such databases as PubMed, MedLine, CyberLeninka, and RSCI were used.

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The power of level-1 evidence in umbilical hernia repair: mesh repair is supported by strong evidence

Cited by 2 publications

References 4 publications

Hernia Size and Mesh Placement in Primary Umbilical Hernia Repair

Hernia Size and Mesh Placement in Primary Umbilical Hernia Repair

Current issues of diagnosis and treatment of neonatal omphalocele

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