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A Ten Year Experience with Umbilical Hernias at the VA Boston Health Care System
Divya Shankar BA1, Kamal M.F. Itani MD, FACS2, Vivian M. Sanchez MD, FACS3
1Boston University School of Medicine, Boston, MA, USA 2VA Boston Health Care System, West Roxbury, MA, USA 3VA Boston Health Care System, West Roxbury, MA, USA

Background: Umbilical hernias account for 6-14% of abdominal wall hernias in adults. Despite their commonality, there is little consensus regarding etiology, the best type of repair, and prevention of recurrence. Our study sought to understand patient and operative factors thought to play a role in recurrence rates and surgical outcomes given the ability to track patients long-term.

Methods: A retrospective cohort of 330 patients who underwent umbilical hernia repair at the Boston VA Health Care System between 1998-2008 were identified via CPT code. Patient factors were collected pre- and post-operatively via the CPRS system.

Results: The mean patient age was 58 with a mean BMI of 38.9. 88% of the hernias were repaired electively. 50% were primary tissue repairs and 50% were mesh repairs. A total of 58% had another abdominal or inguinal hernia repaired. The total recurrence rate was 5.7% (n= 19) at a mean of 2.9 years after index repair. 79% of the recurrences were primary tissue repairs. 17 of the 19 recurrences occurred after elective repair. Using the CPRS system, we were able to identify a mortality rate of 30% within a median 5 years post-op.

Conclusion: Preliminary data indicates that the recurrence rate of umbilical hernias in this veteran cohort is comparable to the community's rates of recurrence. Most recurrences occurred after primary repair. 58% of our umbilical hernia repairs had other hernias arguing perhaps a field defect. The high mortality rate of 30% at a median 5 years after the procedure is of unclear etiology.

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