Long-term follow-up after elective adult umbilical hernia repair: low recurrence rates also after non-mesh repairs

• Published in: Hernia : the journal of hernias and abdominal wall surgery 2013-08, Vol.17 (4), p.493-497
• Main Authors: Dalenbäck, J., Andersson, C., Ribokas, D., Rimbäck, G.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Elective Surgical Procedures - adverse effects; Female; Follow-Up Studies; Hernia, Umbilical - surgery; Herniorrhaphy - adverse effects; Herniorrhaphy - methods; Humans; Kirurgi; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pain, Postoperative - etiology; Patient Satisfaction; Recurrence; Retrospective Studies; Surgery; Surgical Mesh; Surgical Wound Infection - etiology; Surveys and Questionnaires; Time Factors
• ISSN: 1265-4906; 1248-9204; 1248-9204
• DOI: 10.1007/s10029-012-0988-0

Purpose The purpose of this study was to establish long-term outcome after elective adult umbilical hernia (AUH) repair. Methods Peri- and postoperative data considering all consecutive procedures at our institution during the time span from 1999 to 2009 were retrospectively gathered and followed by a questionnaire and, if needed, a clinical investigation in early 2011. Results A total of 162 patients (female/male 35 %/65 %) were operated, and 144/162 (89 %) answers were gathered, mean follow-up time 70 months; 77 % were sutured, non-mesh repairs; 94 % of all AUHs were smaller than 3 cm; and 49 % of the operations were performed under local anaesthesia. No perioperative complications were encountered. Five postoperative complications were encountered, two serious, both after mesh-based repairs. Wound infection rate (SSI) was low, 2/144 (1.4 %). 7/144 (4.9 %) recurrences were registered, none if mesh-based techniques were used, giving a recurrence rate of 6.3 % in suture-based repairs, the difference, however, not statistically significant ( p  = 0.141); 2 % reported persistent pain at follow-up, 89 % were overall satisfied with the outcome. Conclusions AUH repair could be performed with low early and long-term complication rates, with low recurrence rates also after non-mesh repairs. A substantial cohort of patients will unnecessary be implanted with meshes if mesh-reinforced repairs should be used on a routine basis, that is, 16 surplus meshes to prevent one recurrence in the present study. We recommend a tailored approach to AUH repair: suture-based methods with defects smaller than 2 cm and mesh-based repairs considered if larger than that.