What is the significance of an umbilical hernia containing mesentery that has mildly increased in size from 3.8 x 3.6 x 3.1 to 5.5 x 4.3 x 4.2?

From the Guidelines

The patient with an umbilical hernia containing mesentery that has increased in size from approximately 3.8 x 3.6 x 3.1 cm to 5.5 x 4.3 x 4.2 cm should undergo surgical consultation for potential hernia repair as soon as possible, given the significant growth and increased risk of complications such as incarceration or strangulation of the herniated mesentery. The presence of mesentery in the hernia sac is noteworthy as it contains blood vessels that supply the intestines, making complications potentially more serious 1.

Key Considerations

• The increase in size of the hernia warrants concern due to the potential for complications, and the presence of mesentery within the hernia sac increases the risk of serious complications if the hernia becomes incarcerated or strangulated.
• Early surgical intervention is critical in preventing complications such as bowel strangulation, which can lead to high morbidity and mortality rates 1.
• The use of mesh in hernia repair, even in emergency settings, has been shown to reduce recurrence rates without significantly increasing the risk of infection, making it a viable option for repair in clean surgical fields 1.
• Given the hernia's size and the patient's condition, conservative management alone is unlikely to be sufficient, and definitive repair with mesh reinforcement is likely the best course of action to prevent future complications.

Recommendations

• Patients should avoid heavy lifting (nothing over 10-15 pounds) until surgical evaluation.
• Monitor for symptoms like increasing pain, redness, or inability to reduce the hernia.
• Seek immediate medical attention if any concerning symptoms occur.
• Surgical consultation should prioritize the assessment of the hernia for potential repair, considering the use of mesh for reinforcement to minimize the risk of recurrence.

Evidence Basis

The recommendation for surgical consultation and potential repair is based on the most recent and highest quality studies available, including the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1, which emphasize the importance of early intervention in preventing complications and the role of mesh repair in reducing recurrence rates. Additionally, considerations from more recent guidelines, such as those related to the management of ascites in cirrhosis 1, highlight the importance of optimizing patient condition before surgery to reduce postoperative morbidity and mortality.

From the Research

Umbilical Hernia Characteristics

• The umbilical hernia in question contains mesentery and has increased in size from 3.8 x 3.6 x 3.1 to 5.5 x 4.3 x 4.2.
• This increase in size may indicate a need for surgical intervention, as larger hernias are more likely to cause complications such as strangulation or rupture 2.

Treatment Options

• Surgery is often indicated for umbilical hernias, especially in symptomatic patients or those with large hernias 3.
• Treatment options include open, laparoscopic, and robotic repair, with mesh implantation recommended to reduce recurrence rates, even in small hernias 3, 2.
• The choice of surgical method depends on the size of the hernial sac and fascial defect, as well as the patient's overall health and medical history 2.

Complications and Recurrence

• Early complications, such as infection or wound issues, can occur after umbilical hernia repair, with a higher risk in larger hernias and patients with underlying medical conditions like type 2 diabetes 2.
• Recurrence rates can also be higher in larger hernias and in patients with certain medical conditions, emphasizing the importance of proper treatment and follow-up care 2, 4.
• The use of mesh in umbilical hernia repair is recommended to reduce recurrence rates, although the optimal treatment approach may vary depending on the individual case and the surgeon's expertise 3, 2, 4.