Which of the following statements about umbilical hernia repair is correct?

Umbilical Hernia Repair: Key Facts and Management Principles

Elective repair is NOT indicated in patients with ascites, as this population requires special consideration and control of ascites prior to surgical intervention. 1, 2

Gender Distribution and Epidemiology

• Umbilical hernias are more common in patients with cirrhosis and ascites, occurring in approximately 20% of these patients 2
• They are not more common in men (contrary to option A)

Pregnancy-Associated Umbilical Hernias

• Spontaneous closure after delivery is common with pregnancy-associated umbilical hernias, not the exception (contrary to option B)

Management in Patients with Ascites

• Elective repair is contraindicated in patients with uncontrolled ascites due to high risk of complications 2, 3
• Control of ascites is recommended before elective herniorrhaphy to reduce complications 2
• Uncontrolled ascites is strongly predictive of hernia recurrence (RR 8.5) 3
• For patients with liver disease, the following factors should be considered:
  • MELD score >15 is associated with significantly higher mortality (11.1% vs 1.3%) 4
  • Albumin level <3.0 g/dL is a predictor of poor outcomes 4
  • Age >65 years increases risk 4

Pediatric Umbilical Hernias

• Pediatric umbilical hernias should be repaired well before age 12 (contrary to option D) 1, 5
• Complications in pediatric umbilical hernias include:
  • Acute incarceration (median age 5 years) 5
  • Recurrent incarceration (median age 3 years) 5
  • Spontaneous evisceration (median age 7 weeks) 5
• Complications typically occur in hernias ≥1.5 cm in diameter 5

Surgical Approach in Cirrhotic Patients

• A multidisciplinary approach involving hepatologist, surgeon, and anesthesiologist is essential 2
• For patients who are liver transplant candidates, hernia repair should be deferred until during or after transplantation 2
• Mesh repair is generally recommended to decrease recurrence rates, although suture repair may be considered for small hernias (<1 cm) 2

Conclusion

Based on the evidence provided, statement C (elective repair is indicated in patients with ascites) is incorrect. The evidence clearly demonstrates that ascites should be controlled prior to elective repair, and patients with uncontrolled ascites have significantly higher risks of complications and recurrence.