Primary umbilical hernia repair: does suture type matter?

Umbilical hernias are a common surgical pathology. Umbilical hernias 2 cm or less are generally treated with open primary suture repair with associated risk of recurrence up to 27 percent. A variety of suture and repair techniques are used with little evidence to suggest which provides the lowest risk of recurrence. The primary goal of our study is to evaluate recurrence rates between primary umbilical hernia repairs with braided and monofilament suture.

We conducted a retrospective review of primary umbilical hernia repairs in patients over the age of 18 performed at a single institution by a group of ten surgeons from November 2018 to November 2023. The primary outcome was comparison of recurrence rates between braided and monofilament suture. Secondary outcomes include recurrence rate of monofilament absorbable versus permanent repair, recurrence rate by repair method, rates of wound infection and suture granulomas.

We evaluated 797 patients that met inclusion criteria with a mean age of 50.9 years, mean BMI 29.6, mean CCI 1.64, and 77% male. We had a 46-month average follow-up via chart review. Mean hernia size was 1.11 cm. 86.4% were repaired with braided (Ethibond) and 13.6% with monofilament (PDS or Prolene) suture. Recurrence rate was 3.9% versus 5.6% for braided and monofilament, respectively, with no significant difference. The incidence of wound complications was not significant between the two groups. There was an increased recurrence rate using the pants over vest repair technique.

Our study indicates that the type of suture used in primary umbilical hernia repairs does not significantly impact the rates of recurrence, wound infection, or suture granuloma formation. However, the pants-over-vest technique is associated with a higher recurrence rate.