Repair of Small Epigastric Hernias

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[RS123]

I have a small epigastric hernia located about 1.5 inches above the top of my navel. The hernia is about the size of a pea, and I can feel it, but there is not a noticeable bulge under the skin that can be seen. I am male, almost 42 years old, 5’8″, weigh about 140-145 pounds (thin and low body fat). I am active both in my personal life (exercise, crossfit, weight lifting, hiking, etc.) and my job also requires strenuous physical activity at times. I have seen two surgeons in the area I live (Oklahoma), and both typically only do mesh repairs. However, for my hernia, both surgeons indicated that they would do a tissue repair with sutures (no mesh). They also both indicated that they would use absorbable/non-permanent sutures. I was surprised to hear that they would use non-permanent sutures because I thought the recurrence rate was believed to be too high if non-permanent sutures were used. I read recently that the use of non-permanent sutures for hernia repair was obsolete. What are your thoughts on using non-permanent sutures for a tissue (no mesh) repair of a small epigastric hernia in an active, thin male that wants to remain active? I’ve also read that recurrence rates for tissue repairs can be highly variable among surgeons, and that it is important to select a surgeon that has a lot of experience in tissue repairs and routinely performs no-mesh tissue repairs. Do you know of any surgeons in the general area that routinely do tissue repairs without mesh? Also, if permanent sutures were to be used, would any type of suture (prolene, stainless steel, braided polyester, etc.) be better in this situation? Thank you.

[sngoldstein]

Repair of Small Epigastric Hernias

I am a hernia surgeon in upstate NY. I normally use mesh but in a tiny hernia like this a single suture should be fine as the defect is probably less than a few millimeters. I only use absorbable sutures because it is the scarring that repairs the hernia, not the sutures. Permanent sutures will eventually saw through the tissues and create another defect. I try to use monofilament whenever possible because there is a lower risk of infection. As long as all the herniated contents are removed an the edges freshened, you should get a good result.

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