A comparison of outcomes between patients with class I and class II obesity undergoing umbilical hernia repair: a multicenter study using the ACQHC database.

PURPOSE: To better understand the gap in literature by comparing umbilical hernia repair techniques for < 2 cm umbilical hernias in patients with class I and class II obesity

Methods

A retrospective review of data from the ACHQC was performed to include adult patients with a BMI of 30.0-39.9 kg/m2 who underwent elective UHR for a hernia defect of < 2 cm. Patients within each obesity underwent propensity score matching analysis for diabetes mellitus, hypertension, chronic obstructive pulmonary disorder, and smoking status. Outcomes of interest included: compare surgical site infection, surgical site occurrence, 30-day reoperation, recurrence, and re-admission.

RESULTS

1896 patients were included in the analysis after matching. There was no difference in 30-day recurrence, re-admission, or reoperation. There was a statistically greater number of SSO in the class II obesity group (4.6% vs 2.8%, p = 0.04), but no difference in SSI. When comparing suture-based repair between the obesity classes, there was a higher rate of SSO in patients with class II obesity (18 vs 6, p = 0.002). When comparing open repair with mesh and minimally invasive repair with mesh across the entire cohort, we found a higher readmission rate (7 vs 1, p = 0.038) and SSO rate (12 vs 3, p = 0.019) in patients with class II obesity undergoing open repair with mesh. There was no difference in SSI or SSO between the classes when undergoing MIS repair with mesh.

CONCLUSION

Minimally invasive repair for umbilical hernias < 2 cm is favored over open repair in patients with class I or class II obesity in regards to wound morbidity and early postoperative hernia recurrence .