What is the recommended treatment for a fat supraumbilical hernia?

Treatment of Fat Supraumbilical Hernia

Prosthetic repair with a synthetic mesh is the recommended treatment for fat supraumbilical hernia due to significantly lower recurrence rates compared to tissue repair, without an increase in wound infection rates. 1

Surgical Approach Based on Hernia Characteristics

Clean Surgical Field (No Intestinal Strangulation)

• Mesh repair is strongly recommended for supraumbilical hernias in clean surgical fields (CDC wound class I) 1
• The mesh should be placed in the preperitoneal space with at least 3 cm overlap of the hernia defect 2
• Advantages of mesh repair include:
  • Lower long-term complication rates 1
  • Significant reduction in recurrence rates (0% with mesh vs 19% without mesh in paraumbilical hernias) 1
  • Low rates of wound infection (comparable to suture repair) 1

Surgical Technique Options

• Open mesh repair technique (onlay technique) is commonly used 3
• Laparoscopic approach may be considered for uncomplicated hernias with the following benefits:
  • Lower wound infection rates 1
  • Shorter hospital stay 1
  • Ability to place mesh in preperitoneal space, avoiding potential complications of intra-abdominal mesh placement 4

Special Considerations

Hernia Size

• For small defects (<1 cm), suture repair may be considered 2
• For defects ≥2 cm, mesh repair is strongly preferred due to higher recurrence rates with suture repair (10.5% vs 9% for <2 cm) 3

Patient Factors

• Body Mass Index (BMI) >30 kg/m² is associated with higher recurrence rates (10.7% vs 8.6% for BMI <30) 3
• For obese patients with large hernias, careful preoperative planning including CT imaging may be necessary 5

Complicated Hernias

• In cases of intestinal incarceration without strangulation, mesh repair remains recommended 1
• For strangulated hernias with intestinal compromise:
  • If no gross enteric spillage (CDC wound class II), emergent prosthetic repair with synthetic mesh is still recommended 1
  • If bowel necrosis or gross enteric spillage is present (CDC wound class III/IV), primary repair is recommended for small defects (<3 cm) 1

Postoperative Considerations

• Expected recovery time after surgery is approximately 2.4 months 3
• Potential complications include:
  • Wound infection (rates around 5.2%) 3
  • Pain or discomfort (reported in approximately 20.9% of patients) 3
  • Recurrence (overall rate around 8.9%) 3

Follow-up

• Patients should be followed for at least 6 months postoperatively to monitor for complications and recurrence 6
• Most patients (83.6%) report good outcomes after umbilical hernia repair 3