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

• 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 70months; 77% were sutured, non-mesh repairs; 94% of all AUHs were smaller than 3cm; 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 2cm and mesh-based repairs considered if larger than that.

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MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

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