Journal Review in Hernia Surgery: Umbilical Hernias in Complex Patient Populations

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 7 April 2022

⏱️ 49 minutes

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Summary

Umbilical hernias a common diagnoses that general surgeons must manage. Though these hernias are considered relatively simple problems to resolve, certain populations of patients are prone to higher rates of complications. As abdominal wall surgery has advanced, so to have the options that exist in management of primary umbilical hernias. The session will review common clinical circumstances and high-risk patient presentations. We will generally review the approaches to repair and the thought processing and data driving decision making.
· Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair.
· Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair.
· Dr. Shahrose Rahman is a resident in General Surgery at Oregon Health & Science University.

Seminal Papers in Umbilical Hernia Management
Guidelines for treatment of umbilical and epigastric hernias (Henriksen et al. Br J Surg. 2020.): https://pubmed.ncbi.nlm.nih.gov/31916607/

Hernia-Neck Ratio: Predicting Factors for Complications of Umbilical Hernias (Fueter et al. WJS. 2016.): https://pubmed.ncbi.nlm.nih.gov/27194561/

Safety and effectiveness of umbilical hernia repair in patients with cirrhosis (Hew et al. Hernia. 2018.):https://pubmed.ncbi.nlm.nih.gov/29589135/

Fix it while you can...Mortality after umbilical hernia repair in cirrhotic patients (Hill et al. Amer Journal of Surgery. 2020.): https://pubmed.ncbi.nlm.nih.gov/32988606/

Postoperative complications with retromuscular mesh placement in emergency incisional hernia repair (Juul et al. Scand J Surg. 2021.): https://pubmed.ncbi.nlm.nih.gov/33092472/

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Transcript

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0:00.0	Behind the Night, the surgery podcast, relevant and engaging content designed to help you dominate the day.
0:13.0	Alright, welcome to another episode of the Hurnia series on Behind the Knife.
0:27.0	It's an exciting time to talk about some complex scenarios for a simple problem, known as umbilical hernias.
0:35.0	So clearly that was just some sarcasm, but we're going to talk about complex patients dealing with umbilical hernias and how to manage them.
0:44.0	Today I'm joined by my partner, Sean Ornstein, and one of our residents that always just you should roast for a month.
0:51.0	And we're going to talk all about umbilical hernia.
0:54.0	Let's get rolling now.
0:58.0	So many of us think about umbilical hernias is a simple problem.
1:02.0	But for abdominal wall surgeons, oftentimes when you talk to patients who present with complex abdominal wall defects and loss of domain.
1:11.0	If you really talk to them, you may hear that the index operation that happened under abdominal wall was actually an umbilical hernia repair.
1:19.0	The goal oftentimes is to avoid long term complications or hernia recurrences.
1:26.0	So we'll talk about some patients who are prone to recurrence and complications.
1:32.0	So sure. So whenever you're thinking about a patient and you're trying to, you know, have your best possible outcome.
1:38.0	What are some of the factors that go into decision making?
1:42.0	Right factors are finding and identifying the right patient, performing the correct operation and doing that operation at the right time in order to achieve the best possible outcome for that patient.
1:56.0	Exactly. Unfortunately that that equation that you describe in reality is often imperfect and many of those factors are either sub optimized or can't be optimized in advance of an operation.
2:09.0	Today, what we're going to do is some define objective measures of risk for patients who present with ventral hernias or umbilical hernias.
2:17.0	We're going to summarize data on management of high risk scenarios in umbilical hernia and then we'll review some strategies to mitigate risk and improve outcomes.
2:27.0	So let's get started. Let's talk about how we assess risk.
2:31.0	So Dr. Orinstein, when you're thinking about grading patient risk factors for ventral hernias or umbilical hernias, what are some of the things you think of all?
2:42.0	There's a lot of factors that go into evaluating for somebody for a hernia repair.
2:48.0	Part of it is the description of the herni itself. Is it large size? Is it recurrent? Is there other mesh in place? Do they have a history of infection or they high risk for infection? Is there bound involvement?
	...

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