Elective Umbilical Hernia Repair in Adults in the 21st Century: Challenging the Status Quo.

On the spectrum of complexity for general surgery operations, umbilical hernia repair (UHR) is on the light side. After inguinal hernias, they are the most commonly repaired hernias and, as such, umbilical hernias are an important component of a general surgery practice. Since the time at which WJ Mayo published his seminal technique on the repair of umbilical hernias, multiple strategies for the management of umbilical hernias have emerged ranging from watchful waiting to open repair, as well as minimally invasive approaches. The present perspective maintains that each approach has its merits depending on the patient, surgeon, and institution. However, randomized controlled trials and clinical practice guidelines have favored some approaches over others. Similarly, recommendations have been developed regarding body mass index classification as well as hernia size for mesh placement. Other factors important to UHR are the choice of anesthesia and smoking cessation for elective repair. Though we do not contest well-designed randomized controlled trials (RTCs), or clinical guidelines, we offer our perspective on the care of these common hernias.