Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society.
Autor: Henriksen, N. A.; Montgomery, A.; Kaufmann, R.; Berrevoet, F.; East, B.; Fischer, J.; Hope, W.; Klassen, D.; Lorenz, R.; Renard, Y.; García Ureña, Miguel Ángel; Simons, M. P.
Resumen: Background: Umbilical and epigastric hernia repairs are frequently performed surgical procedures with
an expected low complication rate. Nevertheless, the optimal method of repair with best short- and
long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical
and epigastric hernias.
Methods: The guideline group consisted of surgeons from Europe and North America including members
from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations,
Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate
Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research
and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018,
and updated on 1 February 2019.
Results: Literature reporting specifically on umbilical and epigastric hernias was limited in quantity
and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality
evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to
reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach
with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large,
or if the patient has an increased risk of wound morbidity.
Conclusion: This is the first European and American guideline on the treatment of umbilical and
epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired
by an open approach with a preperitoneal flat mesh.
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