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Treatment of small (< 2 cm) umbilical hernias: guidelines and current trends from the Herniamed Registry

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Abstract

Introduction

Based on meta-analyses and registry data, the European Hernia Society and the Americas Hernia Society have published guidelines for the treatment of umbilical hernias. These recommend that umbilical hernia should generally be treated by placing a non-absorbable (permanent) flat mesh into the preperitoneal space with an overlap of the hernia defect of 3 cm. Suture repair should only be considered for small hernia defects of less than 1 cm. Hence, the use of a mesh in general is subject to controversial debate particularly for small (< 2 cm) umbilical hernias. This analysis of data from the Herniamed Registry now presents data on the treatment of small (< 2 cm) umbilical hernias over the past 10 years.

Methods

Herniamed is an Internet-based hernia registry in which hospitals and surgical centers in Germany, Austria and Switzerland can voluntarily enter data on their routine hernia operations. Between 2010 and 2019, data were entered into the Herniamed Registry by 737 hospitals/surgery centers on a total of 111,765 patients with primary elective umbilical hernia repair. The prospective data were analyzed retrospectively for each year and statistically compared. Due to a higher number of cases, the years 2013 and 2019 were compared for the perioperative outcome and the years 2013 and 2018 for 1-year follow-up. Fisher’s exact test was applied for unadjusted analyses between the years, using a significance level of alpha = 5%. For post hoc tests of single categories, a Bonferroni adjustment for multiple testing was implemented.

Results

A mesh technique was used to treat 45.4% of all umbilical hernias. The proportion of small (< 2 cm) umbilical hernias in the total collective of umbilical hernias was 55.6%. Suture repair was used consistently over the 10-year period to treat around 75% of all small (< 2 cm) umbilical hernias. Preperitoneal mesh placement as recommended in the guidelines was used only in 1.8% of cases. Between 2013 and 2019, stable values of 2 and 0.7% were observed for the postoperative complications and complication-related reoperations, respectively, with no relevant effect identified for the surgical technique. At 1-year follow-up, significantly higher rates of pain at rest (2.6 vs. 3.3), pain on exertion (5.7 vs. 6.6), and recurrences (1.3 vs. 1.8) (all p < 0.05) were identified for 2018 compared with 2013.

Conclusions

A suture technique is still used to treat 75% of patients with small (< 2 cm) umbilical hernias. The pain and recurrence rates are significantly less favorable for 2018 compared with 2013.

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Funding

This descriptive analysis was only possible with the funding support of the “Austrian Hernia Forum”.

Author information

Author notes

  1. F. Köckerling and W. Brunner have contributed equally to this publication.

Authors and Affiliations

  1. Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany

    F. Köckerling

  2. Department of Surgery, Kantonspital St. Gallen, Rorschacher Str. 95, CH-9007, St. Gallen, Switzerland

    W. Brunner

  3. Department of General Surgery, Faculty of Medicine, Sigmund Freud University, Freudplatz 3, 1020, Vienna, Austria

    R. Fortelny

  4. Department of Surgery, Paracelsus Medical University Salzburg, University Hospital of Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria

    F. Mayer

  5. StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany

    D. Adolf

  6. Hansechirurgie, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany

    H. Niebuhr

  7. Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany

    R. Lorenz

  8. Wilhelmsburger Hospital Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany

    W. Reinpold

  9. Marien Hospital Düsseldorf, Rochusstrasse 2, 40479, Düsseldorf, Germany

    K. Zarras

  10. University Hospital of Visceral Surgery, Pius Hospital Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany

    D. Weyhe

Authors
  1. F. Köckerling
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  2. W. Brunner
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  3. R. Fortelny
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  4. F. Mayer
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  5. D. Adolf
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  6. H. Niebuhr
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  7. R. Lorenz
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  8. W. Reinpold
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  9. K. Zarras
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Corresponding author

Correspondence to F. Köckerling.

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Conflict of interest

Dr. Köckerling reports grants from Johnson & Johnson, Norderstedt, grants from Karl Storz, Tuttlingen, grants from pfm medical, Cologne, grants from Dahlhausen, Cologne, grants from B Braun, Tuttlingen, grants from MenkeMed, Munich, grants from Bard, Karlsruhe, during the conduct of the study; personal fees from Bard, Karlsruhe, outside the submitted work. All other authors have nothing to disclose.

Ethical approval

As only cases of routine hernia surgery are documented in the Herniamed Registry, an ethical approval was not neccessary.

Human and animal rights

This article does not contain any study with animals performed by any of the authors.

Informed consent

All patients with routine hernia surgery documented in the Herniamed Registry have signed an informed consent declaration agreeing to participate.

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Köckerling, F., Brunner, W., Fortelny, R. et al. Treatment of small (< 2 cm) umbilical hernias: guidelines and current trends from the Herniamed Registry. Hernia 25, 605–617 (2021). https://doi.org/10.1007/s10029-020-02345-w

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  • DOI: https://doi.org/10.1007/s10029-020-02345-w

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