WP1.12 - Unveiling Evidence Gaps in Emergency Umbilical Hernia Repair: A Scoping Review Free

Umbilical hernias may become acutely symptomatic, strangulated, or obstructed, necessitating emergency intervention. Robust evidence is required for high-quality care in this field. This scoping review aims to elucidate the existing evidence gaps in emergency care of umbilical hernias.

A systematic search of EMBASE, MEDLINE, and CENTRAL databases was conducted using a predefined strategy. Primary research reporting on any aspect of emergency umbilical hernia care and published in the English language were eligible for inclusion. Two independent authors screened abstracts and full texts, resolving disagreements through consensus or a third author. Data was charted according to core concepts addressed by each study and a narrative synthesis was performed.

The search generated 299 abstracts, with 32 full texts assessed and 14 included in the final review. This encompassed 52,042 patients undergoing emergency umbilical hernia care. Studies were predominantly retrospective cohort designs (10/14), evenly distributed between single (6/14) and multi-centre (8/14), with only one randomised trial. Most multi-centre studies utilised national databases (7/8). Themes arising included risk profile (n=4), timing of surgery (n=4), investigations (n=1), repair method (n=8, 4 mesh vs suture; 4 laparoscopic vs open), and operative outcomes (n=11). Commonly reported outcomes were mortality (n=9), morbidity (n=7), and length of hospital stay (n=5).

This scoping review demonstrates the paucity of high-quality data concerning emergency umbilical hernia care. The significant evidence gaps highlight a pressing need for randomised trials addressing timing and technical aspects of repair, incorporating patient-reported outcomes.