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Should a Mesh be used in small Paraumbilical (Umbilical) Hernia Cases?

Umbilical Hernia
Umbilical Hernia

Both mesh and suture repair are used for the treatment of umbilical hernias, but for smaller umbilical hernias (diameter 1–4 cm) there was little evidence whether mesh repair would be more beneficial than suture repair. Usually the use of mesh for small umbilical hernias is mostly governed by surgeon's preference. In practice, many small umbilical hernias were being repaired by sutures. The result of a new trial suggests otherwise.

This was a randomised, double-blind, controlled, multicentre trial by Ruth Kaufmann et al. conducted at Erasmus University Medical Center, Netherlands and  published on 16th Feb 2018 in The Lancet . This was first study showing high level evidence for mesh repair in patients with small hernias of diameter 1–4 cm. 

Eligible participants were adults aged at least 18 years with a primary umbilical hernia of diameter 1–4 cm. A total of 300 patients were randomly assigned, 150 to mesh repair and 150 to suture repair.

The primary outcome was the rate of recurrences of the umbilical hernia after 24 months assessed in the modified intention-to-treat population by physical examination and, in case of any doubt, abdominal ultrasound.

After a maximum follow-up of 30 months, there were fewer recurrences in the mesh group than in the suture group (6 in 146 mesh repair patients [4%] vs 17  in 138 suture repair patients [12%]).

The most common postoperative complications were seroma (one [<1%] in the suture group vs five [3%] in the mesh group), haematoma (two [1%] vs three [2%]), and wound infection (one [<1%] vs three [2%]).



Conclusion


In addition to patients with large umbilical hernias, mesh repair should also be used for operations on all patients with small umbilical hernias of size 1 to 4 cm. 


Reference

Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30298-8/fulltext


Keywords: Mesh vs Suture Repair for Umbilical Hernia

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