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Invited Commentary
May 2017

Complexity of the “Simple” Umbilical Hernia Repair

Author Affiliations
  • 1Division of Surgical Oncology, Department of Surgery, The University of North Carolina at Chapel Hill
JAMA Surg. 2017;152(5):466. doi:10.1001/jamasurg.2016.5053

The repair of abdominal wall hernias is the most commonly performed surgical procedure. For many surgeons, it is one of the earliest procedures performed during training. As with many “simple” things, however, repairing abdominal wall hernias has substantial hidden complexity.

In this issue of JAMA Surgery, Shankar et al1 illustrate the complexities of one subset of abdominal wall hernia—the umbilical hernia. The authors studied a historical cohort of patients who had umbilical hernia repairs at the VA (Veterans Affairs) Boston Healthcare System between January 1, 1998, and December 31, 2008, and analyzed events that occurred through June 1, 2014. To date, this study is the longest follow-up published for such a group of patients. The VA system has many advantages for long-term studies, including a robust electronic medical record system and a relatively stable patient population. The authors point out a “small patient migration outside of the VA system,” but unfortunately this migration is not clearly quantified in the study.