What size of umbilical (navel) hernia requires mesh repair?

From the Guidelines

All umbilical hernias, regardless of size, can be repaired with mesh in emergency situations with intestinal strangulation and/or concomitant need of bowel resection without gross enteric spillage, as it is associated with a significant lower risk of recurrence and no increase in 30-day wound-related morbidity 1. When considering the use of mesh for umbilical hernia repair, several factors come into play, including the size of the hernia defect, the presence of complications, and the patient's overall health status.

• In general, the size of the hernia defect is a key factor in determining the need for mesh reinforcement, with larger defects typically requiring mesh to reduce the risk of recurrence.
• However, according to the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1, mesh can be used in emergency situations regardless of the size of the hernia defect, as long as there is no gross enteric spillage.
• The use of mesh in these situations is associated with a lower risk of recurrence and no increase in 30-day wound-related morbidity, making it a viable option for emergency repairs.
• Other factors, such as obesity, previous hernia recurrence, and underlying connective tissue disorders, may also influence the decision to use mesh, even for smaller defects.
• The type of mesh used and the technique of mesh placement (open or laparoscopic) can vary depending on surgeon preference and patient factors.

From the Research

Umbilical Hernia Size and Mesh Placement

• The size of an umbilical hernia that requires mesh placement is not clearly defined, with varying recommendations in the literature 2.
• A study found that primary umbilical hernias less than 2.3 cm can be successfully treated with tissue repair, but larger hernias may benefit from mesh placement 2.
• Another study suggested that mesh placement is commonly recommended for hernias greater than 2.0 cm in size, but the evidence is heterogeneous and based on different study designs and patient populations 2.

Comparison of Mesh and Non-Mesh Repair

• A study comparing mesh and non-mesh repair for incisional hernias less than 2 cm found no difference in recurrence rates, but mesh repair was associated with higher postoperative complications 3.
• A review of inguinal and femoral hernia repair found that mesh repair probably reduces the risk of hernia recurrence compared to non-mesh repair, but may result in more seromas and wound swelling 4.
• A study on the darn technique for small midline hernias found promising long-term results with low recurrence rates, suggesting that mesh may not be necessary for small hernias 5.

Hernia Size and Recurrence

• A study found that hernia size was associated with recurrence in univariable analysis, but not in multivariable analysis, suggesting that other factors may also play a role in recurrence 2.
• A review of the literature found inconsistent guidance on the specific hernia size that requires mesh placement, highlighting the need for further research in this area 2.