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Fewer recurrences of small umbilical hernias repaired with mesh than with sutures
Clinical Question
Do patients with small umbilical hernias repaired with mesh have fewer recurrences than those with hernias repaired with sutures?
Bottom line
Patients with small umbilical hernias had fewer recurrences after 2 years with mesh repair than with suture repair. The rate of complications in both approaches was low. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Self-funded or unfunded
Setting: Inpatient (any location) with outpatient follow-up
Synopsis
Currently, suture repair is the standard of care for small umbilical hernias. These authors conducted an international multicenter study that compared suture repair with mesh repair in 300 patients 18 years and older with 1-cm to 4-cm diameter umbilical hernias. Each participating center agreed to use common surgical techniques and postoperative analgesia (diclofenac or acetaminophen). Although the surgeons knew which approach they were using (I should hope so!), the patients and the outcome assessors did not know which patients had mesh repair and which had suture repair of the hernia. The researchers assessed (by intention to treat) the primary outcome, hernia recurrence after 2 years, serially at 2 weeks, then at 3, 12, 24, and 30 months after surgery. The authors report that no patient had any anesthesia complication or postoperative death. Additionally, the rate of postoperative pain, mechanical complaints, and the rate of cross-over to the alternate surgical approach were all similar for the patients in each treatment group. Overall, by the end of the study, only 6 patients treated with mesh had a recurrence compared with 17 of those treated with sutures (number needed to treat = 13; 95% CI 7 - 56). Complications were infrequent in each group: seroma (3% vs < 1%), hematoma (2% vs 1%), and wound infection (2% vs 1%) for mesh versus suture repair, respectively.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Good poem
I am surprised about the age of these patients. Normally, I refer my patients for surgical repair soon after their 5th. birthday.
Complications appear to be significantly higher in those who had the mesh repair compared to the sutures repair method for all 3 parameters mentioned.
for Q4, either method has its drawbacks
[Overall, by the end of the study, only 6 patients treated with mesh had a recurrence compared with 17 of those treated with sutures (number needed to treat = 13; 95% CI 7 - 56). Complications were infrequent in each group: seroma (3% vs < 1%), hematoma (2% vs 1%), and wound infection (2% vs 1%) for mesh versus suture repair, respectively]
I would let the patient to decide.
Surgical repair - 11% recurrence rate over 2 yr period; 1% risk of complication around the wound
Mesh repair - 4% recurrence rate / 2 yrs; 2-3% risk of comlication around the wound site. mesh
Do you have data on how many of the patients with recurrence had repeat repair and by what method?
I presume when the article talks of the size if the hernia, it refers to the size of the defect. I do not consider a 4cm umbilical hernia to be small. My rule of thumb is that, if I would need to increase the size of the defect to be able to lay a preperitoneal mesh, I simply use sutures.