World Journal of Surgery

, Volume 39, Issue 1, pp 121–126 | Cite as

Sutured Repair of Primary Small Umbilical and Epigastric Hernias: Concomitant Rectus Diastasis Is a Significant Risk Factor for Recurrence

  • Gernot Köhler
  • Ruzica-Rosalia Luketina
  • Klaus Emmanuel
Original Scientific Report



Umbilical and epigastric hernias are common in the adult population and prompt repair is advised. We aimed to evaluate the impact of concomitant rectus diastasis on the outcome of patients who underwent primary sutured fascia closure of a hernia without mesh.


We performed a retrospective analysis of 231 consecutive adult patients who had undergone elective suture-based repair of small (<2 cm) and primary umbilical or epigastric hernias with respect to complications, recurrence, and chronic pain.


Patients with rectus diastasis suffered from a significantly increased rate of hernia recurrence (29/93 vs. 9/108; p < 0.001). The use of absorbable sutures also had a negative influence on the recurrence rate (26/90 vs. 12/111; p = 0.001). Obesity (body mass index > 35 kg/m2) was associated with more complications (p = 0.02). Wound infections following hernia repair also were associated with a higher rate of recurrence (p = 0.08) and chronic pain (p = 0.02). The mean follow-up via a structured questionnaire was 31 months (range 3–59) and data were available for 201 of 231 patients (87 %).


We strongly recommend preoperatively checking for rectus diastasis and using nonabsorbable sutures as an alternative to mesh repair only when repairing small umbilical or epigastric hernias (<2 cm) and there is no concomitant rectus diastasis. Patients with coexistent rectus diastasis definitely benefit from mesh-based repair of the midline to decrease the recurrence rate.


Hernia Repair Hernia Recurrence Mesh Repair Suture Repair Nonabsorbable Suture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The author thanks the study nurses who helped in data acquisition and data management. The kind statistical support of Mag. Michael Stumpner is greatly acknowledged.

Conflicts of interest

Gernot Köhler has no conflicts of interest or financial ties to disclose.


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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Gernot Köhler
    • 1
    • 2
    • 3
  • Ruzica-Rosalia Luketina
    • 1
    • 2
    • 3
  • Klaus Emmanuel
    • 1
    • 2
    • 3
  1. 1.Department of General and Visceral SurgerySisters of Charity HospitalLinzAustria
  2. 2.Academic Teaching Hospital of the University of GrazGrazAustria
  3. 3.Academic Teaching Hospital of the University of InnsbruckInnsbruckAustria

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