Umbilical Hernia in an Obese Patient

Umbilical hernia showing as a soft tissue opacity on an erect abdomen X-ray film

Obese patients with umbilical hernia comprise a special group. Apart from anaesthetic considerations for an obese patient, following are few technical points to consider before taking an obese patient for surgery.

Obesity with BMI > 30 kg/m2 is one of the factor for surgical failure[1]

The patient’s BMI >30 kg/m2 and defects >2 cm have been reported as possible factors for surgical failure in a study by Venclauskas et al. Ninety-seven patients (Males:31 and Females:66) with umbilical hernia were examined in this study.  The recurrence rate was higher when hernia size was >2 cm (9% for <2 cm vs 10.5% for >2 cm) and patient's BMI was >30 kg/m(2) (8.6% for < 30 vs 10.7% for >30). 

Thus it is wise to counsel the patient for weight loss before an elective umbilical hernia surgery.

Laparoscopic umbilical hernia repair is better than open repair in Obese patients [2]

A comparative study by Colon et al. (2013) stated that laparoscopic umbilical hernia repair should be the preferred approach in obese patients. They found a significant increase in wound infection rate in the open mesh repair group when compared with the laparoscopic procedure (26% vs. 4%; p<0.05). They observed no hernia recurrence in the laparoscopic group, whereas the open group had 4% recurrence rate.


References

[1] https://www.ncbi.nlm.nih.gov/pubmed/19124962/

[2] https://www.sciencedirect.com/science/article/pii/S0002961012004369



Keywords: Umbilical Hernia and Obesity, Umbilical Hernia, Mesh, Suture, Mesh Repair, Suture Repair, Obesity, BMI

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SHOULD A MESH BE USED IN SMALL UMBILICAL HERNIA CASES?
http://www.worldsurgeryforum.net/2018/03/should-mesh-be-used-in-all-umbilical-hernias.html

3/05/2018 01:32:00 AM

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

3/05/2018 12:21:00 AM