What is the recommended treatment approach for a small left periumbilical hernia with a 6 mm abdominal wall fascial defect in a corrections setting?

From the Guidelines

For a small left periumbilical hernia with a 6 mm abdominal wall fascial defect in a corrections setting, watchful waiting is the recommended initial approach. This conservative management involves monitoring the hernia for changes while avoiding surgical intervention unless complications develop. The patient should be educated to avoid heavy lifting (over 25 pounds) and activities that increase intra-abdominal pressure. They should be taught to recognize warning signs requiring urgent evaluation, including severe pain, nausea, vomiting, inability to reduce the hernia, or skin changes over the hernia site, which may indicate incarceration or strangulation. Regular follow-up examinations every 3-6 months are advised to assess for changes in size or symptoms. A hernia support belt or binder may provide symptomatic relief if the hernia causes discomfort. This approach is appropriate because small hernias (under 1 cm) without symptoms have a low risk of complications, and the restricted access to surgical facilities in corrections settings makes conservative management practical. Elective surgical repair would only be considered if the hernia becomes symptomatic, enlarges significantly, or if the patient is approaching release and has access to post-release surgical care, as suggested by guidelines for emergency repair of complicated abdominal wall hernias 1.

Some key points to consider in the management of this patient include:

• The use of mesh in clean surgical fields is associated with a lower recurrence rate, as noted in the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1.
• For patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection, the surgical field is presumed clean, and the infectious risk for synthetic mesh is low 1.
• The management of mesh-site infections is challenging and always requires an individualized approach combining medical and surgical approaches, with consideration for the use of biological meshes in contaminated fields 1.
• The choice between a cross-linked and a non-cross-linked biological mesh should be evaluated depending on the defect size and degree of contamination, as discussed in the context of emergency hernia repair in contaminated fields 1.

However, given the specific context of a small, asymptomatic periumbilical hernia in a corrections setting, watchful waiting remains the most appropriate initial approach, prioritizing the patient's morbidity, mortality, and quality of life outcomes.

From the Research

Treatment Approach for Small Left Periumbilical Hernia

The recommended treatment approach for a small left periumbilical hernia with a 6 mm abdominal wall fascial defect in a corrections setting is primarily surgical. The key considerations include:

• The size and location of the hernia
• The presence of any complications or risks associated with the hernia
• The overall health and medical history of the patient

Surgical Options

Surgical options for repairing a periumbilical hernia include:

• Open repair: This involves making an incision near the hernia and repairing the defect with sutures or mesh 2, 3.
• Laparoscopic repair: This is a minimally invasive approach that uses small incisions and a camera to repair the hernia 4, 3.
• Mesh repair: This involves using a mesh material to reinforce the weakened area of the abdominal wall 5, 3.

Considerations for Corrections Setting

In a corrections setting, the treatment approach may need to take into account additional factors, such as:

• The availability of medical resources and personnel
• The need to minimize recovery time and facilitate return to normal activities
• The potential for complications or risks associated with the hernia or the surgical procedure

Recommended Approach

Based on the available evidence, a laparoscopic mesh repair may be a suitable option for a small left periumbilical hernia with a 6 mm abdominal wall fascial defect in a corrections setting 4, 3. This approach can help to minimize recovery time and reduce the risk of complications. However, the final decision on the treatment approach should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.