umbilical hernia with Austin hernia specialists

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Umbilical Hernias The Case for No-Mesh Repairs
Austin hernia specialists
Patients with small umbilical or ventral hernias
(size of the defect less than 2 cm) and BMI less
than 30 kg/m2 may benefit from primary hernia
repair (closure of the defect with resorbable
sutures and without mesh). These operations can
be performed through a small incision hidden
inside the navel, which leads to an esthetically
pleasing scar once the healing is complete.
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Older data suggests that in patients with low
BMI, the recurrence rate is 14 without mesh,
versus 4 with mesh repairs. However, the study
included a very heterogeneous group of patients,
with defects up to 4 cm, which is quite large for
a primary repair. Nonetheless, those patients
still had an 86 chance of a successful
repair. With quality data lacking, the 2020
guidelines by the American Hernia Society and
European Hernia Society advise repair with mesh
in all umbilical and ventral hernias to decrease
the chance of recurrence, when compared with
suture repair alone. However, we find the
technique recommended in the article (open
preperitoneal repair with mesh) to be highly
variable among different surgeons and with
inconsistent results. Furthermore, the
above-mentioned guidelines do not address the
long-term consequences of open repairs with
preperitoneal mesh. Lastly, a 2022 Article found
that long-term recurrence rates after tissue
repair (no mesh) of small umbilical hernias (lt1
cm) was only 1.8. Thus, patients with small
umbilical hernias undergoing a suture repair
have a 98.2 chance of not having a
recurrence. In patients with larger defects or
obesity (BMIgt30) the recurrence rates can be
significantly increased after a primary repair,
due to the unbalanced tension exercised on the
tissues by the sutures. Therefore, most
authorities recommend mesh reinforcement in this
category of patients. Various techniques are
employed based on patient factors and hernias
characteristics. The best one will be chosen at
the time of the surgical consultation. Special
consideration should be given to patients who
have an umbilical hernia and associated
diastasis recti (separation of the rectus
abdominis muscles, which forms a crease when
sitting up from a flat position). This condition
is common after pregnancy but can also be
encountered in other instances. The ideal
situation is correction of the diastasis recti
with physical therapy exercises, and postponing
the umbilical hernia repair for a few months,
until the separation is resolved. However, in
patients unable to completely correct the
diastasis, various surgical techniques exist to
achieve this surgically at the same time with the
umbilical hernia repair.
Austin hernia specialists