Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults

Background: Prosthetic repair has become the standard method for inguinal h ernia and has excellent results. The question remains of whether the mesh t echnique could also improve results for umbilical defects. Methods: The study was a randomized clinical trial comparing herniorrhaphy (primary suture) with hernioplasty (polypropylene mesh or plug) in 200 adul t patients with a primary umbilical hernia. Patients at high anaesthetic ri sk (American Society of Anesthesiologists (ASA) grade IV) or those who need ed emergency surgery were excluded. The mean postoperative follow-up was 64 months. The population studied included 118 women and 82 men with a mean a ge at presentation of 57 years. Some 173 patients were ASA grade I-II and 2 7 were ASA III. The anaesthetic technique of choice was local anaesthetic i nfiltration plus sedation (98 per cent). Results: There were no significant anaesthetic complications or surgical de aths. The mean duration of surgery was greater for mesh than for suture rep air (45 versus 38 min). Rates of early complications such as seroma, haemat oma or wound infection were similar in the two groups. The hernia recurrenc e rate was higher after suture repair (11 per cent) than after mesh repair (1 per cent) (P = 0.0015). Conclusion: Prosthetic repair could become the standard treatment for prima ry umbilical hernia in adults.