Umbilical hernia, Mayo or mesh?

Summary

Unlike inguinal herniorraphy, the results of surgery for umbilical hernia have been poorly audited. The extent to which the popular sutured repair of Mayo has given way to mesh-based repairs in recent years is also unknown. To investigate these deficiencies, a review was undertaken of 651 umbilical hernia repairs performed between April 1994 and March 1999 at a single institution by 10 general surgeons.

Excluding children and umbilical hernias repaired at laparotomy, a total of 473 primary adult hernias and 18 recurrent hernias were repaired. The proportion repaired for recurrence was 3.8%. Follow up ranges between 12 and 60 months (mean 27 months, median 25 months).

Of the 18 recurrences, there were 16 sutured repairs and 11 of the patients had predisposing factors for recurrence such as wound infection, obesity, chronic renal failure or ascites.

Sutured repair of primary umbilical hernias in this large series was successful in 96% of cases; in the remainder underlying co-morbidity was an important predisposing factor for recurrence.

This study does not support the routine use of mesh in primary adult umbilical hernia repair.