Mesh vs. suture repair of small umbilical hernias. Strong evidence supporting mesh repair

Although there is good evidence that large umbilical hernias should be repaired with a mesh, it is not clear how smaller hernias should be managed i.e. those with a diameter 1-4 cm. Many surgeons continue to suture repair these smaller hernias.

The autors of this multicentre trial (12 hospitals located in Holland, Germany and Italy) randomised 300 patients to either a sutured or mesh repair. The surgeons performed a standardised technique and patients, ivestigators and analysts were blinded to the type of surgery that was perfomred (of course, the surgeons who performed the operation were aware.. we hope!). Hernias were 1- 4 cm in size. The study ran between 2006 and 2014. Median follow-up was 25 months.
The authors reported in the Lancet that there were fewer recurrences in the mesh group compared to the suture repair group (4% vs 12%). This was equivalent to an estimated 2-year recurrence rate of 3.6% for mesh repair vs. 11.4% for sutured repair (p=0.01). The most common postoperative complication was seroma (<1%: suture group vs 3%: mesh repair), haematoma (1% vs 2%), and wound infection (<1% vs 2%). There were no anaesthetic complications or postoperative deaths.
This is an excellent high quality study that reinforces once again the benefits of mesh repair of hernias. This study focused on small umbilical hernias and suggest that just about all umbilical hernias should be treated with a mesh repair.
Kaufmann R, Halm JA, Eker HH, et al. Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. The Lancet; doi.org/10.1016/S0140-6736(18)30298-8.  Access full-text article on The Lancet, 
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