Efficacy of the Anterior Rectus Sheath Hinge Graft for Umbilical Hernia Repair Reinforcement

Francis B Baccay, MD¹, Melanie Howell, MD¹, Irene J Lo, MD², Jai P Singh, MD³. ¹Montefiore Medical Center/Albert Einstein College of Medicine, ²West Coast Surgical Associates, Inc, ³SUNY Upstate Medical Center

Introduction: The anterior rectus sheath has been used in various hernia repairs to traverse the defect.  In this series, we describe a novel technique that uses the anterior rectus sheath as a reinforcement material for the open umbilical hernia repair.  We report our experience with this innovative approach.

Method: A total of 54 consecutive umbilical hernia patients including 34 (63%) elective and 20 (37%) emergent were repaired. All hernias were repaired using open technique employing an omega incision centered around the umbilicus. The umbilical hernia was primarily repaired in transverse fashion. The repair was reinforced with medial mobilization of an anterior rectus sheath hinge flap that was sutured directly to the hernia repair suture line.  No synthetic or biologic reinforcement material used.

Result: There were no recurrences or re-admissions.  Mean age was 52.2 years (27-78 years), mean body mass index of 36.3 kg/m2 (25.3-42.2kg/m2), mean follow-up was 36.2 months (10- 54 mo), and mean length of stay was 3.8 days (0-6 days).  There were 16 patients (29.6%) with ascites with mean MELD score 12.4 (8-20).  There were 2 (3.7%) wound infections.  There were 6 patients (11.1%) that required bowel resection.

Conclusion: We describe a novel technique to open umbilical hernia repairs obviating the need for any prosthetic material.  The direct suture line reinforcement of the anterior rectus sheath flap maintained proper flap alignment and reduced tension at the suture line.  Larger prospective trials comparing outcome with standard techniques are warranted.