title: Sutured repair of primary small umbilical and epigastric hernias: concomitant rectus diastasis is a significant risk factor for recurrence.
abstract: BACKGROUND
  Umbilical and epigastric hernias are common in the adult population and prompt repair is advised. We aimed to evaluate the impact of concomitant rectus diastasis on the outcome of patients who underwent primary sutured fascia closure of a hernia without mesh.
  
  
  METHODS
  We performed a retrospective analysis of 231 consecutive adult patients who had undergone elective suture-based repair of small (<2 cm) and primary umbilical or epigastric hernias with respect to complications, recurrence, and chronic pain.
  
  
  RESULTS
  Patients with rectus diastasis suffered from a significantly increased rate of hernia recurrence (29/93 vs. 9/108; p < 0.001). The use of absorbable sutures also had a negative influence on the recurrence rate (26/90 vs. 12/111; p = 0.001). Obesity (body mass index > 35 kg/m(2)) was associated with more complications (p = 0.02). Wound infections following hernia repair also were associated with a higher rate of recurrence (p = 0.08) and chronic pain (p = 0.02). The mean follow-up via a structured questionnaire was 31 months (range 3-59) and data were available for 201 of 231 patients (87 %).
  
  
  CONCLUSIONS
  We strongly recommend preoperatively checking for rectus diastasis and using nonabsorbable sutures as an alternative to mesh repair only when repairing small umbilical or epigastric hernias (<2 cm) and there is no concomitant rectus diastasis. Patients with coexistent rectus diastasis definitely benefit from mesh-based repair of the midline to decrease the recurrence rate.
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria, gernot.koehler@bhs.at.
authors.forename: Gernot
authors.initials: G
authors.lastname: Köhler
authors.forename: Ruzica-Rosalia
authors.initials: RR
authors.lastname: Luketina
authors.forename: Klaus
authors.initials: K
authors.lastname: Emmanuel
mesh_terms: D000009:Abdominal Muscles / Q000473:pathology; D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000601:surgery*; D006554:Hernia, Umbilical / Q000453:epidemiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D013536:Suture Techniques; D013537:Sutures