title: Long-term follow-up after elective adult umbilical hernia repair: low recurrence rates also after non-mesh repairs.
abstract: OBJECTIVE
  The purpose of this study was to establish long-term outcome after elective adult umbilical hernia (AUH) repair.
  
  
  METHODS
  Peri- and postoperative data considering all consecutive procedures at our institution during the time span from 1999 to 2009 were retrospectively gathered and followed by a questionnaire and, if needed, a clinical investigation in early 2011.
  
  
  RESULTS
  A total of 162 patients (female/male 35 %/65 %) were operated, and 144/162 (89 %) answers were gathered, mean follow-up time 70 months; 77 % were sutured, non-mesh repairs; 94 % of all AUHs were smaller than 3 cm; and 49 % of the operations were performed under local anaesthesia. No perioperative complications were encountered. Five postoperative complications were encountered, two serious, both after mesh-based repairs. Wound infection rate (SSI) was low, 2/144 (1.4 %). 7/144 (4.9 %) recurrences were registered, none if mesh-based techniques were used, giving a recurrence rate of 6.3 % in suture-based repairs, the difference, however, not statistically significant (p = 0.141); 2 % reported persistent pain at follow-up, 89 % were overall satisfied with the outcome.
  
  
  CONCLUSIONS
  AUH repair could be performed with low early and long-term complication rates, with low recurrence rates also after non-mesh repairs. A substantial cohort of patients will unnecessary be implanted with meshes if mesh-reinforced repairs should be used on a routine basis, that is, 16 surplus meshes to prevent one recurrence in the present study. We recommend a tailored approach to AUH repair: suture-based methods with defects smaller than 2 cm and mesh-based repairs considered if larger than that.
authors.affiliation: Department of Surgery, Frölunda Specialist Hospital, Box 138, 421 22 Västra Frölunda, Gothenburg, Sweden. jan.dalenback@vgregion.se
authors.forename: J
authors.initials: J
authors.lastname: Dalenbäck
authors.forename: C
authors.initials: C
authors.lastname: Andersson
authors.forename: D
authors.initials: D
authors.lastname: Ribokas
authors.forename: G
authors.initials: G
authors.lastname: Rimbäck
mesh_terms: D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006554:Hernia, Umbilical / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000209:etiology; D011795:Surveys and Questionnaires; D013997:Time Factors