Current practice patterns for initial umbilical hernia repair in the United States.

Area of Science:

• Abdominal surgery
• Surgical outcomes
• Hernia repair techniques

Background:

• Initial umbilical hernia (IUH) repair approaches vary significantly.
• Factors influencing repair decisions include hernia size, patient demographics, comorbidities, and surgeon preference.
• Hernia size is the most studied factor, but other variables' impact on practice patterns remains less clear.

Purpose of the Study:

• To investigate the practice patterns of initial umbilical hernia repair in the United States.
• To identify patient and hernia characteristics associated with surgical approach and mesh utilization.

Main Methods:

• Retrospective analysis of 3475 patients from the America Hernia Society Quality Collaborative.
• Data collected included patient age, sex, hernia width, BMI, smoking status, and diabetes.
• Multivariate logistic regression assessed the impact of these factors on mesh use and surgical approach (open vs. minimally invasive).

Main Results:

• Mesh use was higher in men (67% vs. 60%) and for hernias >1 cm (82% vs. 33%).
• Younger patients (≤35 years) were less likely to receive mesh repair.
• Multivariate analysis showed mesh use correlated with increased hernia width (OR 5.47) and BMI (OR 1.8), but not age or sex.

Conclusions:

• Most initial umbilical hernias are repaired using open techniques.
• Patient BMI and hernia defect size influence the choice of surgical technique and mesh use.
• The observed 33% mesh use for hernias <1 cm indicates a discrepancy between current evidence and clinical practice.