Double Running Suture Line Repair in Primary Umbilical Hernias - Analysis after 282 Cases

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There is an ongoing debate as to which patients presenting with an umbilical hernia should be operated with the sole suture technique or augmented by mesh. After treating most of our patients for a long period uniformly with a double running suture line, the aim of this study was to evaluate the performance of this strategy - especially in patients with larger defects. From 1/2004 to 4/2017, all patients operated on for an umbilical hernia were identified through our hospital information system (KIS). The relevant documents for each case - such as operation and discharge reports, anaesthesia protocol, and information on the clinical course were extracted and the critical parameters entered into a database program (FileMaker® 12.0). Adult patients (≥ 18 y) with a double running suture line, excluding recurrences and surgery simultaneously to minimally invasive interventions, receiving surgery on umbilical defects ≤ 2 cm (size 1) were compared to those with defects > 2 cm (size 2). Long-time results were gathered from the KIS, follow-up investigations, questionnaires and telephone interviews. Chi-square and Mann-Whitney U tests were applied; p < 0.05 was considered significant. 515 operations for umbilical hernias were identified, of which 282 were primary cases with double running suture. The follow-up was 77%. Only cases with follow-up information were considered. Patients with size 1 (n = 147) were significantly younger than patients with size 2 (n = 69; 51 vs. 54 years; p = 0.0012), had a lower BMI (29 vs. 33; p = 0.003) and tended to have lower ASA score (2 vs. 2; p = 0.0837). Complications were seen in 8/147 (5%) vs. 4/69 (6%) cases, respectively (p = 0.9174). The recurrence rate after a median of 4,6 years was in 6/147 in size 1 (4%) vs. 4/69 (6%) in size 2 (p = 0.5759). The use of a double running suture line with non-absorbable material with umbilical hernias led to good results in our patients. Repair of primary umbilical hernias was mostly successful, independently of the size of the defect, even in older patients with greater body weight.