Permanent composed mesh umbilical hernia
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Permanent Mesh in Umbilical Hernia Repair: Efficacy and Complications
Introduction to Umbilical Hernia Repair
Umbilical hernias are a common condition where part of the intestine protrudes through an opening in the abdominal muscles near the navel. The use of permanent mesh in the repair of these hernias has been a topic of extensive research, particularly in terms of reducing recurrence rates and managing complications.
Efficacy of Permanent Mesh in Reducing Recurrence Rates
Comparative Studies on Mesh vs. Suture Repair
Several studies have demonstrated that the use of permanent mesh significantly reduces the recurrence rates of umbilical hernias compared to suture repair. A randomized controlled trial involving 300 patients showed that mesh repair had a lower recurrence rate (4%) compared to suture repair (12%) over a follow-up period of 30 months. Similarly, a meta-analysis of randomized controlled trials confirmed that open mesh repair is associated with a significantly lower incidence of recurrence compared to suture repair (odds ratio 0.22).
Specific Findings in Cirrhotic Patients
In cirrhotic patients, who are at higher risk for complications, the use of polypropylene mesh has been shown to result in significantly fewer recurrences without the need for mesh removal due to complications. This suggests that permanent mesh can be a viable option even in high-risk patient groups.
Complications Associated with Permanent Mesh
Short-term and Long-term Complications
While permanent mesh is effective in reducing recurrence rates, it is not without complications. Early wound morbidity and clinical outcomes associated with permanent synthetic mesh, such as polypropylene, have been compared to resorbable polymers like poly-4-hydroxybutyrate (P4HB). Studies found no significant difference in early wound morbidity, readmission, or reoperation rates between the two types of mesh. However, concerns remain regarding potential long-term complications such as mesh exposure, infection, and fistula formation.
Specific Complications in Intraperitoneal Placement
The placement of mesh intraperitoneally has been associated with serious late complications, including small bowel resection and mesh removal due to improper deployment and adhesion formation. Therefore, preperitoneal deployment is often recommended to minimize these risks.
Guidelines and Current Trends
Recommendations for Small Umbilical Hernias
For small umbilical hernias (<2 cm), guidelines generally recommend the use of a non-absorbable flat mesh placed in the preperitoneal space with an overlap of the hernia defect by 3 cm. Despite these recommendations, suture repair is still commonly used, particularly for very small defects, due to concerns about complications and the need for more extensive dissection with mesh placement .
Ongoing Research and Trials
The SUMMER trial is a prospective, randomized, double-blind clinical trial comparing onlay mesh to suture repair for small umbilical hernias. This trial aims to provide more definitive data on the recurrence rates and complications associated with these two methods. Additionally, the MORPHEUS trial compared flat preperitoneal polypropylene mesh repair with patch repair, finding that the former was associated with fewer complications.
Conclusion
The use of permanent mesh in umbilical hernia repair has been shown to significantly reduce recurrence rates compared to suture repair. However, the choice of mesh type and placement technique is crucial to minimize complications. Ongoing research and adherence to guidelines will continue to refine the best practices for umbilical hernia repair, ensuring optimal outcomes for patients.
Sources and full results
Most relevant research papers on this topic
Management of complicated umbilical hernias in cirrhotic patients using permanent mesh: randomized clinical trial
Early wound morbidity and clinical outcomes associated with P4HB mesh compared to permanent synthetic mesh in umbilical and small to medium, routine ventral hernia repairs
Complications of mesh devices for intraperitoneal umbilical hernia repair: a word of caution
Treatment of small (< 2 cm) umbilical hernias: guidelines and current trends from the Herniamed Registry
SUMMER Trial: mesh versus suture repair in small umbilical hernias in adults—a study protocol for a prospective randomized double-blind multicenter clinical trial
Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial
Does mesh offer an advantage over tissue in the open repair of umbilical hernias? A systematic review and meta-analysis
Mesh OR Patch for Hernia on Epigastric and Umbilical Sites (MORPHEUS-Trial): The Complete Two-year Follow-up.
Open mesh versus suture repair of umbilical hernia: Meta-analysis of randomized controlled trials.
Novel Approach for Umbilical Hernia Repair Using Mesh Strips
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