Quality of life after umbilical hernia surgery with a preperitoneal mesh – our experience

Czech version

Authors: M. Páral ^1,2; T. Paseka ^1,2 ; P. Diviš ¹; K. Abukhovich ¹; J. Vrbka ¹ ; J. Doležel ¹; L. Pospíšil ²; A. Texl ²
Authors‘ workplace: Chirurgické oddělení, SurGal Clinic s. r. o., Brno ¹; Lékařská fakulta MU, Brno ²
Published in: Rozhl. Chir., 2026, roč. 105, č. 7, s. 337-343.
Category: Original articles
doi: https://doi.org/10.48095/ccrvch2026337

Overview

Introduction: Umbilical hernia is a common health problem; it is the second most common hernia worldwide. According to their size, they are divided into small, medium, and large. Umbilical hernias with a diameter of 1–4 cm (medium) are currently recommended to be operated on using the technique of inserting a preperitoneal flat mesh. Our study aimed to assess the impact of this operation on the quality of life of patients and the number of complications.

Methods: We conducted a retrospective analysis. The study included patients operated on at the Surgical ward of the Surgalclinic hospital between January 1, 2022, and May 31, 2024. We used the standard Carolinas Comfort scale questionnaire to assess quality of life and the Clavien-Dindo classification to evaluate complications.

Results: A total of 131 patients were included in the study, and 91 patients completed the questionnaire. There were 61 men and 30 women with a mean age of 50.5 years, regardless of gender, median age of 49 (28–79). Most patients were in the ASA I–II category (95%), median BMI was 30.1 (17–42.4), mean was 29.3. According to the Carolinas Comfort scale, 79.1% of patients had a very good quality of life two weeks after surgery. One month after surgery, this was reported by 93.4% of patients and 1 year after surgery, by 94.5%.We identified six complications, of which four were mild according to the Clavien-Dindo classification and two were serious and required further surgery. An extended totally extraperitoneal approach was used in both cases with good results.

Conclusions: Surgery of medium-sized umbilical hernias using the preperitoneal mesh method appears to be a safe and well-tolerated method with few complications and, in a significant majority of cases, without a negative impact on long-term quality of life. Although our study suggests the suitability of this procedure, these conclusions should be approached with caution, especially since these are results from a single centre and a retrospective analysis.

Keywords:

Quality of life – umbilical hernia – preperitoneal mesh

Sources

1. Shankar DA, Itani KM, O’Brien WJ et al. Factors associated with long-term outcomes of umbilical hernia repair. JAMA Surg 2017; 152 (5): 461–466. doi: 10.1001/jamasurg.2016.5052.

2. Dabbas N, Adams K, Pearson K et al. Frequency of abdominal wall hernias: is classical teaching out of date? JRSM Short Rep 2011; 2 (1): 5. doi: 10.1258/shorts.2010.010071.

3. Henriksen NA, Montgomery A, Kaufmann R et al. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg 2020; 107 (3): 171–190. doi: 10.1002/bjs.11489.

4. Kulaçoğlu H. Current options in umbilical hernia repair in adult patients. Ulus Cerrahi Derg 2015; 31 (3): 157–161. doi: 10.5152/UCD.2015.2955.

5. Bedewi MA, El-Sharkawy MS, al Boukai AA et al. Prevalence of adult paraumbilical hernia. Assessment by high-resolution sonography: a hospital--based study. Hernia 2012; 16 (1): 59–62. doi: 10.1007/s10029-011-0863-4.

6. Heniford BT, Lincourt AE, Walters AL et al. Carolinas comfort scale as a measure of hernia repair quality of life: a reappraisal utilizing 3788 international patients. Ann Surg 2018; 267 (1): 171–176. doi: 10.1097/SLA.0000000000002027.

7. Heniford BT, Walters AL, Lincourt AE et al. Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 2008; 206 (4): 638–644. doi: 10.1016/j.jamcollsurg.2007.11.025.

8. Nielsen K, Poelman MM, den Bakker FM et al. Comparison of the Dutch and English versions of the carolinas comfort scale: a specific quality-of-life questionnaire for abdominal hernia repairs with mesh. Hernia 2014; 18 (4): 459–464. doi: 10.1007/s10029-013-1173-9.

9. Mayo WJ. VI. An Operation for the Radical Cure of Umbilical Hernia. Ann Surg 1901; 34 (2): 276–280. doi: 10.1097/00000658-190107000-00021.

10. Shrestha D, Shrestha A, Shrestha B. Open mesh versus suture repair of umbilical hernia: meta-analysis of randomized controlled trials. Int J Surg 2019; 62 : 62–66. doi: 10.1016/j.ijsu.2018.12.015.

11. Melkemichel M, Stjärne L, Bringman S et al. Onlay mesh repair for treatment of small umbilical hernias ≤ 2 cm in adults: a single-centre investigation. Hernia 2022; 26 (6): 1483–1489. doi: 10.1007/s10029-021-02509-2.

12. Earle D, Roth JS, Saber A et al. SAGES Guidelines for laparoscopic ventral hernia repair. Surg Endosc 2016; 30 (8): 3163–3183. doi: 10.1007/s00464-016-5072-x.

13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (2): 205–213. doi: 10.1097/01.sla.0000133083.54934.ae.

14. Looft P, Alfarawan F, Bockhorn M et al. Beyond traditional repair: comparing etep and open sublay for ventral hernia repair. J Clin Med 2025; 14 (8): 2586. doi: 10.3390/jcm14082586.

15. Anders DL, Pawlak MM, Simons MP et al. Midline incisional hernia guidelines: the European Hernia Society. Br J Surg 2023; 110 (12): 1732–1768. doi: 10.1093/bjs/znad284.

16. Belyansky I, Daes J, Radu VG et al. A novel approach using the enhanced-view totally extraperitoneal (ETEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 2018; 32 (3): 1525–1532. doi: 10.1007/s00464-017-5840-2.

17. Holt AC, Bamarni S, Leslie SW. Umbilical Hernia. Treasure Island (FL): StatPearls Publishing 2024.

18. Madsen LJ, Oma E, Jorgensen LN et al. Mesh versus suture in elective repair of umbilical hernia: systematic review and meta-analysis 2020. BJS Open 2020; 4 (3): 369–379. doi: 10.1002/bjs5.50276

19. Sanders DL, Pawlak MM, Simons MP et al. Midline incisional hernia guidelines: the european hernia society. Br J Surg 2023; 110 (12): 1732–1768. doi: 10.1093/bjs/znad284.

20. Helgstrand F, Jørgensen LN, Rosenberg J et al. Nationwide prospective study on readmission after umbilical or epigastric hernia repair. Hernia 2013; 17 (4): 487–492. doi: 10.1007/s10029-013-1120-9.

21. Bencini L, Sanchez LJ, Bernini M et al. Predictors of recurrence after laparoscopic ventral hernia repair. Surg Laparosc Endosc Percutan Tech 2009; 19 (2): 128–132. doi: 10.1097/SLE.0b013e31819cb04b.

22. Zucker BE, Simillis C, Tekkis P et al. Suture choice to reduce occurrence of surgical site infection, hernia, wound dehiscence and sinus/fistula: a network meta-analysis. Ann R Coll Surg Engl 2019; 101 (3): 150–161. doi: 10.1308/rcsann.2018.0170.

23. Salminen P, Kow L, Aminian A et al. IFSO Consensus on Definitions and Clinical Practice Guidelines for Obesity Management –⁠ an International Delphi Study. Obes Surg 2024; 34 (1): 30–42. doi: 10.1007/s11695-023-06913-8.