Predictors of recurrence of umbilical hernias following primary tissue repair in obese veterans

Yao, Jie; Pham, Thai H.; Mokdad, Ali El; Huerta, Sergio

doi:10.1016/j.amjsurg.2015.03.014

Cited by 15 publications

(20 citation statements)

References 22 publications

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“…However, we had an older cohort of patients (57.7 ± 11.6 vs 53 ± No SD years), higher BMI (32.3 ± 4.76 vs 27.9 ± No SD Kg/m 2 ), more men (97% vs 70%), higher percentage of patients with a history of smoking (64.4% vs 36%), and bigger hernias (2.7 ± 1.39 vs 1.4 ± No SD cm). 2 However, in disagreement with Kang's et al 1 report, we have found that there is no correlation between BMI and recurrence in two separate studies in our patient population. 2,3 Previously, we have shown only two recurrences of 47 umbilical hernia repairs (UHRs) in patients with a BMI 35 to 39.9 and 1 of 14 UHRs in patients with a BMI >40.…”

Section: To the Editorcontrasting

confidence: 99%

“…2 However, in disagreement with Kang's et al 1 report, we have found that there is no correlation between BMI and recurrence in two separate studies in our patient population. 2,3 Previously, we have shown only two recurrences of 47 umbilical hernia repairs (UHRs) in patients with a BMI 35 to 39.9 and 1 of 14 UHRs in patients with a BMI >40. 2 In our patient population, most patients were unable to lose weight and demonstrate no desire to undergo bariatric operations.…”

Section: To the Editorcontrasting

confidence: 99%

“…2,3 Previously, we have shown only two recurrences of 47 umbilical hernia repairs (UHRs) in patients with a BMI 35 to 39.9 and 1 of 14 UHRs in patients with a BMI >40. 2 In our patient population, most patients were unable to lose weight and demonstrate no desire to undergo bariatric operations. Oftentimes, these patients unnecessarily did not have surgical intervention for symptomatic UHs.…”

Section: To the Editormentioning

confidence: 99%

See 2 more Smart Citations

Primary Repair of Umbilical Hernias: Evidence of Feasibility

Meier

Huerta

2020

The American Surgeon™

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Section: To the Editorcontrasting

confidence: 99%

Section: To the Editorcontrasting

confidence: 99%

Section: To the Editormentioning

confidence: 99%

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Primary Repair of Umbilical Hernias: Evidence of Feasibility

Meier

Huerta

2020

The American Surgeon™

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“…Four small case series 25 -28 reported no association between obesity and recurrence, whereas obesity was reported to be an independent risk factor for recurrence in two other studies 29,30 . Wound infection after primary repair may be associated with an increased recurrence rate 29,31 , but other studies 27,28,32 could not confirm this finding.…”

Section: Quality Of Evidence: Strength Of Recommendation: Weakmentioning

confidence: 92%

Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society

Henriksen

Montgomery

Kaufmann

et al. 2020

British Journal of Surgery

228

198

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Background: Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short-and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. Methods: The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019. Results: Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity. Conclusion: This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.

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“…4 However, tissue repair is still commonly performed for primary UHs in many centers with experience in the technique. [5][6][7][8][9][10] Primary tissue repair reduces the risk of surgical site infections (SSIs); if an infection does occur, it is more readily managed than a mesh repair SSI. 11,12 Albeit rare, other more serious complications have been reported following mesh repair of UH related to migration of the mesh into surrounding organs.…”

Section: Introductionmentioning

confidence: 99%

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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Predictors of recurrence of umbilical hernias following primary tissue repair in obese veterans

Cited by 15 publications

References 22 publications

Primary Repair of Umbilical Hernias: Evidence of Feasibility

Primary Repair of Umbilical Hernias: Evidence of Feasibility

Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society

Hernia Size and Mesh Placement in Primary Umbilical Hernia Repair

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