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Mesh better than sutures for small umbilical hernias

Reinforcement using mesh works better than sutures for small navel hernias. When using sutures, the navel hernia is three times as likely to come back.

Every year about 4,500 people in the Netherlands undergo surgery for a navel hernia. This is a problem in the abdominal wall that can cause pain and trapping of the intestine. In some cases the hernia is repaired using sutures, but mesh is also used. This is synthetic reinforcement material that is surgically implanted. These meshes received much media attention in recent years. However, Erasmus MC researchers conclude that the meshes appear to work extremely well for small umbilical hernias. The navel hernias come back more than three times as often if only sutures are used instead of mesh. In other words, contrary to what is often thought, the mesh is much better for this condition.

navelbreukmatje"The mesh does not cause any more pain or complications than sutures", says research physician Ruth Kaufmann. "And it means that people do not have to come back as often for another operation. This can also result in considerable savings in the ever-increasing Dutch healthcare costs".

Less painful
In recent years, the media have published reports on the negative effects of surgery using mesh as a result of using mesh for sagging of the pelvic floor. At the time, there were reports of patients with constant pain and little prospect of improvement. In the case of umbilical hernias, the likelihood of pain is less anyway. "This area has fewer nerves than the pelvic floor and groin. This means that using a mesh around the navel is therefore much less painful", says Kaufmann.

The study was conducted without funding from the companies that manufacture the mesh, which means that the research was independent. The study focusses on small umbilical hernias, with a diameter of 1 to 4 centimeters. The benefits of using mesh for larger navel hernias had previously already been demonstrated by Erasmus MC researchers. This is the first time ever that a study of this size has been carried out on the use of mesh for smaller umbilical hernias.

Erasmus MC's so-called HUMP (Umbilical Hernia: Mesh versus Primary suture) study examined 300 patients at home and abroad. Half of the navel hernia patients examined had undergone surgery using sutures. The other half had mesh implanted. Both groups were monitored for two years after surgery.

The study was conducted by Erasmus MC's 'R.E.P.A.I.R.' research group and started by Professors Hans Jeekel and Johan Lange.  The results will shortly be published in the leading medical journal The Lancet and can already be found online. Research physician Ruth Kaufmann hopes to receive her PhD for the research this year from Erasmus University Rotterdam.

Date published: 19 February 2018.

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