Abdominoplasty With Umbilical Hernia Repair: A Long-term Comparative Analysis of Clinical Outcomes

Abstract

Background The risks and benefits of performing small fat-containing ventral or umbilical hernia repair (HR) during cosmetic abdominoplasty remains a reconstructive and aesthetic challenge for plastic surgeons. Objectives This study aimed to compare clinical outcomes in patients undergoing abdominoplasty with concurrent HR and abdominoplasty alone. Methods Retrospective review of patients undergoing abdominoplasty with and without a concurrent HR from January 2015- June 2022 was performed. Patients were stratified by concurrent HR. All hernia patients underwent primary fascial repair, without the use of mesh. Demographics, surgical site occurrences (SSO) and cosmetic complications, including delayed healing and necrosis were assessed. Multivariate analysis was used to compare association of umbilical hernia repair with clinical outcomes. Results One hundred and six patients underwent abdominoplasty, 68 (64%) had concurrent HR. No significant difference in demographics was identified between groups including mean BMI (HR=27.2 kg/m2 and No HR= 26.3 kg/m2, P=0.73), and number of previous open hernia repairs (P=0.09). After a mean follow-up of 1.5 years, hernia recurrence rate was 1.4% (n=1), with a time to hernia recurrence of 12.2 months. After controlling for confounders, there was no difference in risk of SSO (OR 1.02 [0.31-3.36] P=0.978), cosmetic complications (OR 0.80 [0.14-4.57] P=0.805), procedure length (-21.5 minutes [-46.92-22.93] P=0.501), readmissions (2.8% vs. 0%, P=0.336), or reoperations (8.8% vs. 10%, P=0.766), compared to patients who underwent abdominoplasty alone. Conclusions Abdominoplasty with concurrent HR can be performed safely and effectively, with no increase in adverse outcomes or cosmetic complications. The benefit of performing mesh-free HR with abdominoplasty can achieve an enhanced aesthetic outcome and reduce long-term abdominal wall morbidity.