Koebe S, Greenberg J, Huang L-C, Phillips S, Lidor A, Funk L, Shada A
University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA.
Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53736, USA.
Hernia. 2021 Jun;25(3):563-570. doi: 10.1007/s10029-020-02164-z. Epub 2020 Mar 11.
The approach to repairing an initial umbilical hernia (IUH) varies substantially, and this likely depends on hernia size, patient age, sex, BMI, comorbidities including diabetes mellitus, and surgeon preference. Of these, only hernia size has been widely studied. This cross-sectional study aims to look at the practice pattern of umbilical hernia repair in the United States.
A retrospective study was performed using data from the America Hernia Society Quality Collaborative. Patient characteristics included age, sex, hernia width, BMI, smoking status, and diabetes. Outcomes were use of mesh for repair, as well as surgical approach (open vs minimally invasive). Multivariate logistic regression was performed to assess the independent effect of age, sex, hernia width, BMI, smoking status, and diabetes on use of mesh and approach to repair.
3475 patients were included. 74% were men. Mesh use was more common in men (67% vs 60%, P < 0.001). Mesh was used in 33% of repairs ≤ 1 cm, and 82% of repairs > 1 cm (P < 0.001). Younger patients were less likely to receive a mesh repair (54% if age ≤ 35 vs 67% for age > 35, P < 0.001). However, on multivariate analysis, mesh use was associated with increasing hernia width (OR 5.474, 95% CI 4.7-6.3) as well as BMI (OR 1.8, 95% CI 1.5-2.1) but not with age or sex.
The majority of IUH are performed open. Patient BMI and hernia defect size contribute to choice of surgical technique including use of mesh. The use of mesh in 33% of hernias below 1 cm demonstrates a gap between evidence and practice. Patient factors including patient age and sex had no impact on operative approach or use of mesh.
修复原发性脐疝（IUH）的方法差异很大，这可能取决于疝的大小、患者年龄、性别、体重指数（BMI）、包括糖尿病在内的合并症以及外科医生的偏好。其中，只有疝的大小得到了广泛研究。这项横断面研究旨在观察美国脐疝修复的实践模式。
利用美国疝学会质量协作组的数据进行回顾性研究。患者特征包括年龄、性别、疝宽度、BMI、吸烟状况和糖尿病。结局指标为修复时使用补片情况以及手术方式（开放手术与微创手术）。进行多因素逻辑回归分析，以评估年龄、性别、疝宽度、BMI、吸烟状况和糖尿病对补片使用及修复方式的独立影响。
共纳入3475例患者。其中74%为男性。男性使用补片更为常见（67%对60%，P<0.001）。直径≤1厘米的疝修补术中33%使用了补片，而直径>1厘米的疝修补术中这一比例为82%（P<0.001）。年轻患者接受补片修补的可能性较小（年龄≤35岁者为54%，年龄>35岁者为67%，P<0.001）。然而，多因素分析显示，补片使用与疝宽度增加（比值比[OR]5.474，95%置信区间[CI]4.7 - 6.3）以及BMI增加（OR 1.8，95% CI 1.5 - 2.1）相关，但与年龄或性别无关。
大多数原发性脐疝修补采用开放手术。患者的BMI和疝缺损大小有助于手术技术的选择，包括补片的使用。在直径小于1厘米的疝中33%使用补片，这表明证据与实践之间存在差距。包括患者年龄和性别在内的患者因素对手术方式或补片使用没有影响。
