Systematic review and meta-analysis of mesh versus suture repairs of small umbilical hernias (≤ 2 cm).
Lorcan Moore, Gillian Smith, Aisyah Mansur et al.
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In 30 seconds
This systematic review and meta-analysis compared mesh with suture repair for small umbilical hernias (defects ≤ 2 cm). The primary outcome was postoperative recurrence; secondary outcomes included complications and pain. Mesh repair was associated with fewer recurrences than suture repair (RR 0.46 (95% CI 0.38-0.55, I 2 = 0%, p < 0.00001)), while suture repair had lower risks of haematoma/bleeding and infection. Pain scores did not differ significantly. The authors note that heterogeneous study designs limit interpretation and call for further randomised trials.
Key findings
- Mesh repair was associated with fewer recurrences than suture repair: RR 0.46 (95% CI 0.38-0.55, I 2 = 0%, p < 0.00001).
- Suture repair was associated with lower haematoma/bleeding risk (RR 1.74 95% CI 1.16-2.75, I 2 = 0%, p = 0.0009) and infection risk (RR 1.75, 95% CI 1.18-2.59, I 2 = 0%, p = 0.007).
- Postoperative pain scores did not differ significantly between approaches (RR = 1.20, 95% CI 0.98-1.47, I 2 = 0%, p = 0.07).
- In limited subgroup analysis, onlay mesh was associated with better recurrence outcomes than other mesh positions (p = 0.00162).
Why it matters
Repair choice for small umbilical hernias remains unsettled. These pooled findings highlight a trade-off: mesh repair was associated with fewer recurrences, whereas suture repair had lower bleeding and infection risks. The results can inform discussion of outcomes, but the evidence does not establish a definitive optimal approach, particularly given the review’s stated heterogeneity and limited subgroup analysis.
What to keep in mind
The included studies had heterogeneous designs and variable follow-up periods; the authors describe the mesh-technique subgroup analysis as limited and call for further randomised trials.