- Design
- Systematic review and meta-analysis of randomised and non-randomised studies
- Population
- Adults having repair of umbilical hernias with defects of 2 cm or less
- Primary outcome
- Hernia recurrence
- Effect
- RR 0.46 (95% CI 0.38 to 0.55), I² = 0%; infection RR 1.75 with mesh
A meta-analysis in Hernia pooled studies comparing mesh with suture repair for umbilical hernia defects of 2 cm or less, a group in which practice still varies.
Mesh was associated with fewer recurrences (RR 0.46, 95% CI 0.38 to 0.55, I² = 0%). Suture repair had less haematoma or bleeding (RR 1.74 with mesh) and less infection (RR 1.75 with mesh). Pain did not differ significantly. Among mesh techniques, onlay placement had the lowest recurrence in a limited comparison.
The pooled studies mixed randomised and non-randomised designs and follow-up periods varied. Still, the recurrence result was consistent across studies. For most patients with a small defect, mesh deserves to be the default discussion, with suture reserved for those at high wound risk or with very small defects where the patient prefers it.
- Discuss mesh repair for umbilical defects of 2 cm or less, explaining that recurrence was roughly halved.
- Tell patients that mesh carries a higher chance of wound haematoma and infection.
- Consider suture repair where wound risk is high — poorly controlled diabetes, smoking, or contaminated fields.
- Measure and record the defect size intraoperatively, since the evidence is specific to defects of 2 cm or less.
- Optimise smoking and glucose control before elective repair to reduce the wound cost of mesh.
Why it matters
It challenges the habit of simple suture repair for small defects on the assumption that they rarely recur.
Don't overread it
The pooled studies were mixed in design and follow-up; onlay superiority rests on a limited subgroup comparison.
The statistics, in plain English
A risk ratio of 0.46 means recurrence was less than half as common with mesh, and I² of 0% means the studies agreed. Risk ratios of about 1.75 for bleeding and infection mean those complications were roughly three-quarters more frequent with mesh. A subgroup comparison between mesh positions is weaker evidence than the main comparison.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for general surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free