Suture versus open mesh repair for small umbilical hernia: Results of a propensity-matched cohort study.
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
04
11
2022
revised:
14
04
2023
accepted:
24
05
2023
medline:
8
8
2023
pubmed:
26
6
2023
entrez:
25
6
2023
Statut:
ppublish
Résumé
The objective was to compare the outcomes of open mesh repair versus suture repair for small (≤1 cm in diameter) umbilical hernia. The primary endpoint was the 30-day outcomes including pain, and secondary endpoints were the 2-year outcomes including recurrences and patient-reported outcomes. This propensity-matched, multicenter study was carried out on data collected prospectively in the Hernia-Club database between 2011 and 2021. A total of 590 mesh repairs and 590 suture repairs were propensity score matched (age, sex, body mass index) at a ratio of 1:1. Postoperative pain was assessed using the Verbal Rating Scale-4 and 0‒10 Numerical Rating Scale-11. Mesh insertion was intraperitoneal in 331 patients (56.1%), extraperitoneal in 249 (42.2%), and onlay in 10 (1.7%). The rate of 30-day complications and Numerical Rating Scale-11 pain scores on postoperative days 8 and 30 were similar between the groups, including surgical site occurrences (2.2 vs 1.4% after suture repair). At 1 month, postoperative discomfort (sensation of something different from before) was significantly (P < .0001) more frequent after mesh repair, whereas the rate of relevant (moderate or severe) pain (mesh repair: 1.1% vs suture repair: 2.6%) and the distribution of Numerical Rating Scale-11 scores did not differ between the groups. At the 2-year follow-up, mesh repair patients had fewer reoperated recurrences (0.2% vs 1.7%; P = .035) and no more pain or discomfort than suture repair patients. Both techniques are effective and safe. Mesh repair is likely to reduce the rate of recurrences. Concerns about postoperative pain and infection might not prevent the use of mesh in smallest umbilical hernias.
Sections du résumé
BACKGROUND
The objective was to compare the outcomes of open mesh repair versus suture repair for small (≤1 cm in diameter) umbilical hernia. The primary endpoint was the 30-day outcomes including pain, and secondary endpoints were the 2-year outcomes including recurrences and patient-reported outcomes.
METHODS
This propensity-matched, multicenter study was carried out on data collected prospectively in the Hernia-Club database between 2011 and 2021. A total of 590 mesh repairs and 590 suture repairs were propensity score matched (age, sex, body mass index) at a ratio of 1:1. Postoperative pain was assessed using the Verbal Rating Scale-4 and 0‒10 Numerical Rating Scale-11.
RESULTS
Mesh insertion was intraperitoneal in 331 patients (56.1%), extraperitoneal in 249 (42.2%), and onlay in 10 (1.7%). The rate of 30-day complications and Numerical Rating Scale-11 pain scores on postoperative days 8 and 30 were similar between the groups, including surgical site occurrences (2.2 vs 1.4% after suture repair). At 1 month, postoperative discomfort (sensation of something different from before) was significantly (P < .0001) more frequent after mesh repair, whereas the rate of relevant (moderate or severe) pain (mesh repair: 1.1% vs suture repair: 2.6%) and the distribution of Numerical Rating Scale-11 scores did not differ between the groups. At the 2-year follow-up, mesh repair patients had fewer reoperated recurrences (0.2% vs 1.7%; P = .035) and no more pain or discomfort than suture repair patients.
CONCLUSION
Both techniques are effective and safe. Mesh repair is likely to reduce the rate of recurrences. Concerns about postoperative pain and infection might not prevent the use of mesh in smallest umbilical hernias.
Identifiants
pubmed: 37357098
pii: S0039-6060(23)00310-0
doi: 10.1016/j.surg.2023.05.015
pii:
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
593-601Investigateurs
M Antor
(M)
M Beck
(M)
C Barrat
(C)
C Berney
(C)
D Binot
(D)
J Bousquet
(J)
D Blazquez
(D)
A Bonan
(A)
O Cas
(O)
A Champault-Fezais
(A)
P Chastan
(P)
J-M Chollet
(JM)
J-P Cossa
(JP)
A Dabrowski
(A)
T Delaunay
(T)
S Démaret
(S)
F Drissi
(F)
H Demian
(H)
V Dubuisson
(V)
T Dugue
(T)
G Fromont
(G)
J-F Gillion
(JF)
C Jacquin
(C)
F Jurczak
(F)
H Khalil
(H)
M Launay-Savary
(M)
M Lepère
(M)
D Lépront
(D)
J H Longeville
(JH)
N Le Toux
(N)
J Loriau
(J)
E Magne
(E)
P Ngo
(P)
O Oberlin
(O)
G Passot
(G)
X Pavis d'Escurac
(X)
J B Putinier
(JB)
Y Renard
(Y)
B Romain
(B)
M Soler
(M)
S Roos
(S)
J-M Thillois
(JM)
P Tiry
(P)
P Vu
(P)
R Verhaeghe
(R)
M Warlaumont
(M)
C Zaranis
(C)
Informations de copyright
Copyright © 2023 Elsevier Inc. All rights reserved.