Top

Hernia

Published in:

01-06-2021 | Original Article

Current practice patterns for initial umbilical hernia repair in the United States

Authors: S. Koebe, J. Greenberg, L.-C. Huang, S. Phillips, A. Lidor, L. Funk, A. Shada

Published in: Hernia | Issue 3/2021

Abstract

Purpose

The approach to repairing an initial umbilical hernia (IUH) varies substantially, and this likely depends on hernia size, patient age, sex, BMI, comorbidities including diabetes mellitus, and surgeon preference. Of these, only hernia size has been widely studied. This cross-sectional study aims to look at the practice pattern of umbilical hernia repair in the United States.

Methods

A retrospective study was performed using data from the America Hernia Society Quality Collaborative. Patient characteristics included age, sex, hernia width, BMI, smoking status, and diabetes. Outcomes were use of mesh for repair, as well as surgical approach (open vs minimally invasive). Multivariate logistic regression was performed to assess the independent effect of age, sex, hernia width, BMI, smoking status, and diabetes on use of mesh and approach to repair.

Results

3475 patients were included. 74% were men. Mesh use was more common in men (67% vs 60%, P < 0.001). Mesh was used in 33% of repairs ≤ 1 cm, and 82% of repairs > 1 cm (P < 0.001). Younger patients were less likely to receive a mesh repair (54% if age ≤ 35 vs 67% for age > 35, P < 0.001). However, on multivariate analysis, mesh use was associated with increasing hernia width (OR 5.474, 95% CI 4.7–6.3) as well as BMI (OR 1.8, 95% CI 1.5–2.1) but not with age or sex.

Conclusion

The majority of IUH are performed open. Patient BMI and hernia defect size contribute to choice of surgical technique including use of mesh. The use of mesh in 33% of hernias below 1 cm demonstrates a gap between evidence and practice. Patient factors including patient age and sex had no impact on operative approach or use of mesh.

Porrero JL, Cano-Valderrama O, Marcos A, Bonachia O, Ramos B, Alcaide B, Villar S, Sánchez-Cabezudo C, Quirós E, Alonso MT, Castillo MJ (2015) Umbilical hernia repair: analysis after 934 procedures. Am Surg 81(9):899–903CrossRef

Cassie S, Okrainec A, Saleh F, Quereshy FS, Jackson TD (2014) Laparoscopic versus open elective repair of primary umbilical hernias: short-term outcomes from the American College of Surgeons National Surgery Quality Improvement Program. Surg Endosc 28(3):741–746. https://doi.org/10.1007/s00464-013-3252-5CrossRefPubMed

Appleby PW, Martin TA, Hope WW (2018) Umbilical hernia repair: overview of approaches and review of literature. Surg Clin N Am 98(3):561–576. https://doi.org/10.1016/j.suc.2018.02.001CrossRefPubMed

Dalenbäck J, Andersson C, Ribokas D, Rimbäck G (2013) Long-term follow-up after elective adult umbilical hernia repair: low recurrence rates also after non-mesh repairs. Hernia 17(4):493–497. https://doi.org/10.1007/s10029-012-0988-0CrossRefPubMed

Kaufmann R, Halm JA, Eker HH, Klitsie PJ, Nieuwenhuizen J, van Geldere D, Simons MP, van der Harst E, van 't Riet M, van der Holt B, Kleinrensink GJ, Jeekel J, Lange JF (2018) Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet 391(10123):860–869. https://doi.org/10.1016/S0140-6736(18)30298-8CrossRefPubMed

Aslani N, Brown CJ (2010) Does mesh offer an advantage over tissue in the open repair of umbilical hernias? A systematic review and meta-analysis. Hernia 14(5):455–462. https://doi.org/10.1007/s10029-010-0705-9CrossRefPubMed

Christoffersen MW, Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P, Bisgaard T (2015) Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study. Am J Surg 209(4):725–732. https://doi.org/10.1016/j.amjsurg.2014.05.021CrossRefPubMed

Winsnes A, Haapamäki MM, Gunnarsson U, Strigård K (2016) Surgical outcome of mesh and suture repair in primary umbilical hernia: postoperative complications and recurrence. Hernia 20(4):509–516. https://doi.org/10.1007/s10029-016-1466-xCrossRefPubMed

Misiakos EP, Patapis P, Zavras N, Tzanetis P, Machairas A (2015) Current trends in laparoscopic ventral hernia repair. JSLS. https://doi.org/10.4293/JSLS.2015.00048CrossRefPubMedPubMedCentral

10.

Colavita PD, Tsirline VB, Walters AL, Lincourt AE, Belyansky I, Heniford BT (2013) Laparoscopic versus open hernia repair: outcomes and sociodemographic utilization results from the nationwide inpatient sample. Surg Endosc 27(1):109–117. https://doi.org/10.1007/s00464-012-2432-zCrossRef

11.

Solomon TA, Wignesvaran P, Chaudry MA, Tutton MG (2010) A retrospective audit comparing outcomes of open versus laparoscopic repair of umbilical/paraumbilical herniae. Surg Endosc 24(12):3109–3112. https://doi.org/10.1007/s00464-010-1097-8CrossRefPubMed

12.

Funk LM, Perry KA, Narula VK, Mikami DJ, Melvin WS (2013) Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States. Surg Endosc 27(11):4104–4112. https://doi.org/10.1007/s00464-013-3075-4CrossRefPubMed

13.

Colavita PD, Tsirline VB, Belyansky I, Walters AL, Lincourt AE, Sing RF, Heniford BT (2012) Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair. Ann Surg 256(5):714–722. https://doi.org/10.1097/SLA.0b013e3182734130Discussion 722–713CrossRefPubMed

14.

Papageorge CM, Funk LM, Poulose BK, Phillips S, Rosen MJ, Greenberg JA (2017) Primary fascial closure during laparoscopic ventral hernia repair does not reduce 30-day wound complications. Surg Endosc 31(11):4551–4557. https://doi.org/10.1007/s00464-017-5515-zCrossRefPubMed

15.

R Development Core Team (2008). R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-0. https://www.R-project.org. Accessed 19 Nov 2019

16.

Froylich D, Segal M, Weinstein A, Hatib K, Shiloni E, Hazzan D (2016) Laparoscopic versus open ventral hernia repair in obese patients: a long-term follow-up. Surg Endosc 30(2):670–675. https://doi.org/10.1007/s00464-015-4258-yCrossRefPubMed

17.

Shankar DA, Itani KMF, O'Brien WJ, Sanchez VM (2017) Factors associated with long-term outcomes of umbilical hernia repair. JAMA Surg 152(5):461–466. https://doi.org/10.1001/jamasurg.2016.5052CrossRefPubMedPubMedCentral

18.

Colon MJ, Kitamura R, Telem DA, Nguyen S, Divino CM (2013) Laparoscopic umbilical hernia repair is the preferred approach in obese patients. Am J Surg 205(2):231–236. https://doi.org/10.1016/j.amjsurg.2012.02.022CrossRefPubMed

19.

Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ (2013) Evaluation of high-risk, comorbid patients undergoing open ventral hernia repair with synthetic mesh. Surgery 153(1):120–125. https://doi.org/10.1016/j.surg.2012.06.003CrossRefPubMed

20.

Colavita PD, Belyansky I, Walters AL, Zemlyak AY, Lincourt AE, Heniford BT, Augenstein VA (2014) Umbilical hernia repair with mesh: identifying effectors of ideal outcomes. Am J Surg 208(3):342–349. https://doi.org/10.1016/j.amjsurg.2013.12.031CrossRefPubMed

21.

Oma E, Bisgaard T, Jorgensen LN, Jensen KK (2019) Nationwide propensity score matched study of mesh versus suture repair of primary ventral hernias in women with a subsequent pregnancy. World J Surg 43(6):1497–1504. https://doi.org/10.1007/s00268-019-04940-0CrossRefPubMed

Title: Current practice patterns for initial umbilical hernia repair in the United States
Authors: S. Koebe
J. Greenberg
L.-C. Huang
S. Phillips
A. Lidor
L. Funk
A. Shada
Publication date: 01-06-2021
Publisher: Springer Paris
Published in: Hernia / Issue 3/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-020-02164-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Current practice patterns for initial umbilical hernia repair in the United States

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2021

Endolaparoscopic retromuscular repair of smaller midline ventral hernias—too much for too little?

High recurrence rate of children’s inguinal hernia after percutaneous internal ring suturing: a single-center study

Emergency surgery of the abdominal wall hernias: risk factors that increase morbidity and mortality—a single-center experience

Is there an advantage to laparoscopy over open repair of primary umbilical hernias in obese patients? An analysis of the Americas Hernia Society Quality Collaborative (AHSQC)

Management of ventral hernia in patients with BMI > 30 Kg/m2: outcomes based on an institutional algorithm

Treatment of small (< 2 cm) umbilical hernias: guidelines and current trends from the Herniamed Registry