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

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Abstract

Background

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.

Methods

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.

Results

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 %).

Conclusion

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.

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Acknowledgments

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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Authors and Affiliations

  1. Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria

    Gernot Köhler, Ruzica-Rosalia Luketina & Klaus Emmanuel

  2. Academic Teaching Hospital of the University of Graz, Graz, Austria

    Gernot Köhler, Ruzica-Rosalia Luketina & Klaus Emmanuel

  3. Academic Teaching Hospital of the University of Innsbruck, Innsbruck, Austria

    Gernot Köhler, Ruzica-Rosalia Luketina & Klaus Emmanuel

Authors
  1. Gernot Köhler
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  2. Ruzica-Rosalia Luketina
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  3. Klaus Emmanuel
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Correspondence to Gernot Köhler.

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Köhler, G., Luketina, RR. & Emmanuel, K. Sutured Repair of Primary Small Umbilical and Epigastric Hernias: Concomitant Rectus Diastasis Is a Significant Risk Factor for Recurrence. World J Surg 39, 121–126 (2015). https://doi.org/10.1007/s00268-014-2765-y

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  • DOI: https://doi.org/10.1007/s00268-014-2765-y

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