title: Suture versus preperitoneal polypropylene mesh for elective umbilical hernia repairs.
abstract: BACKGROUND
  Repair of primary ventral hernias (PVH) such as umbilical hernias is a common surgical procedure. There is a paucity of risk-adjusted data comparing suture versus mesh repair of these hernias. We compared preperitoneal polypropylene (PP) repair versus suture repair for elective umbilical hernia repair.
  
  
  METHODS
  A retrospective review of all elective open PVH repairs at a single institution from 2000-2010 was performed. Only patients with suture or PP repair of umbilical hernias were included. Univariate analysis was conducted and propensity for treatment-adjusted multivariate logistic regression.
  
  
  RESULTS
  There were 442 elective open PVH repairs performed; 392 met our inclusion criteria. Of these patients, 126 (32.1%) had a PP repair and 266 (67.9%) underwent suture repair. Median (range) follow-up was 60 mo (1-143). Patients who underwent PP repair had more surgical site infections (SSIs; 19.8% versus 7.9%, P < 0.01) and seromas (14.3% versus 4.1%, P < 0.01). There was no difference in recurrence (5.6% versus 7.5%, P = 0.53). On propensity score-adjusted multivariate analysis, we found that body mass index (odds ratio [OR], 1.10) and smoking status (OR, 2.3) were associated with recurrence. Mesh (OR, 2.34) and American Society of Anesthesiologists (OR, 1.95) were associated with SSI. Only mesh (OR, 3.41) was associated with seroma formation.
  
  
  CONCLUSIONS
  Although there was a trend toward more recurrence with suture repair in our study, this was not statistically significant. Mesh repair was associated with more SSI and seromas. Further prospective randomized controlled trial is needed to clarify the role of suture and mesh repair in PVH.
authors: Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors: Rachel L
authors: RL
authors: Berger
authors: Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors: Linda T
authors: LT
authors: Li
authors: Department of Statistics, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Stephanie C
authors: SC
authors: Hicks
authors: Department of Surgery, University of Texas Health Sciences Center, Houston, Texas. Electronic address: mike.liang@uth.tmc.edu.
authors: Mike K
authors: MK
authors: Liang
mesh_terms: D019072:Antibiotic Prophylaxis; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010537:Peritoneum / Q000601:surgery; D011126:Polypropylenes; D012008:Recurrence; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000209:etiology*; D013536:Suture Techniques
chemical_list: D011126:Polypropylenes
keywords: Mesh; Polypropylene; Recurrence; Seroma; Surgical site infection; Suture; Umbilical hernia; Ventral hernia