A comparison of outcomes between patients with class I and class II obesity undergoing umbilical hernia repair: a multicenter study using the ACQHC database.

Abstract

<h4>Purpose</h4>To better understand the gap in literature by comparing umbilical hernia repair techniques for < 2 cm umbilical hernias in patients with class I and class II obesity Methods: A retrospective review of data from the ACHQC was performed to include adult patients with a BMI of 30.0-39.9 kg/m2 who underwent elective UHR for a hernia defect of < 2 cm. Patients within each obesity underwent propensity score matching analysis for diabetes mellitus, hypertension, chronic obstructive pulmonary disorder, and smoking status. Outcomes of interest included: compare surgical site infection, surgical site occurrence, 30-day reoperation, recurrence, and re-admission.<h4>Results</h4>1896 patients were included in the analysis after matching. There was no difference in 30-day recurrence, re-admission, or reoperation. There was a statistically greater number of SSO in the class II obesity group (4.6% vs 2.8%, p = 0.04), but no difference in SSI. When comparing suture-based repair between the obesity classes, there was a higher rate of SSO in patients with class II obesity (18 vs 6, p = 0.002). When comparing open repair with mesh and minimally invasive repair with mesh across the entire cohort, we found a higher readmission rate (7 vs 1, p = 0.038) and SSO rate (12 vs 3, p = 0.019) in patients with class II obesity undergoing open repair with mesh. There was no difference in SSI or SSO between the classes when undergoing MIS repair with mesh.<h4>Conclusion</h4>Minimally invasive repair for umbilical hernias < 2 cm is favored over open repair in patients with class I or class II obesity in regards to wound morbidity and early postoperative hernia recurrence .