{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T13:07:41Z","timestamp":1787663261987,"version":"build-2736575974"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T00:00:00Z","timestamp":1633996800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T00:00:00Z","timestamp":1633996800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Donegal Clinical and Research Academy"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Umbilical hernia repair, despite its perceived simplicity, is associated with recurrence between 2.7 and 27%, in mesh repair and non mesh repair respectively. Many factors are recognized contributors to recurrence however multiple defects in the linea alba, known to occur in up to 30% of patients, appear to have been overlooked by surgeons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This systematic review assessed reporting of second or multiple linea alba defects in patients undergoing umbilical hernia repair to establish if these anatomical variations could contribute to recurrence along with other potential factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review of all published English language articles was undertaken using databases PubMed, Embase, Web of Science and Cochrane Library from January 2014 to 2019. The search terms \u2018Umbilical hernia\u2019 AND \u2018repair\u2019 AND \u2018recurrence\u2019 were used across all databases. Analysis was specified in advance to avoid selection bias, was registered with PROSPERO (154173) and adhered to PRISMA statement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six hundred and forty-six initial papers were refined to 10 following article review and grading. The presence of multiple linea alba defects as a contributor to recurrence was not reported in the literature. One paper mentioned the exclusion of six participants from their study due multiple defects. In all 11 factors were significantly associated with umbilical hernia recurrence. These included: large defect, primary closure without mesh, high BMI in 5\/10 publications; smoking, diabetes mellitus, surgical site Infection (SSI) and concurrent hernia in 3\/10. In addition, the type of mesh, advanced age, liver disease and non-closure of the defect were identified in individual papers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identified many factors already known to contribute to umbilical hernia recurrence in adults, but the existence of multiple defects in the linea, despite it prevalence, has evaded investigators. Surgeons need to be consider documentation of this potential confounder which may contribute to recurrence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12893-021-01358-1","type":"journal-article","created":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T13:01:11Z","timestamp":1634043671000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Umbilical hernia repair and recurrence: need for a clinical trial?"],"prefix":"10.1186","volume":"21","author":[{"given":"Jennifer","family":"Mannion","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Khalid","family":"Hamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritu","family":"Negi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Johnston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magda","family":"Bucholc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sugrue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,12]]},"reference":[{"issue":"5","key":"1358_CR1","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1080\/110241598750004391","volume":"164","author":"A Paul","year":"1998","unstructured":"Paul A, Korenkov M, Peters S, K\u00f6hler L, Fischer S, Troidl H. Unacceptable results of the Mayo procedure for repair of abdominal incisional hernias. Eur J Surg. 1998;164(5):361\u20137.","journal-title":"Eur J Surg"},{"issue":"5","key":"1358_CR2","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1007\/s10029-010-0705-9","volume":"14","author":"N Aslani","year":"2010","unstructured":"Aslani N, Brown CJ. Does mesh offer an advantage over tissue in the open repair of umbilical hernias? A systematic review and meta-analysis. Hernia. 2010;14(5):455\u201362.","journal-title":"Hernia"},{"issue":"1","key":"1358_CR3","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1007\/s00464-013-3170-6","volume":"28","author":"R Bittner","year":"2014","unstructured":"Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, K\u00f6ckerling F, Kukleta J, Leblanc K, Lomanto D, et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)-part 1. Surg Endosc. 2014;28(1):2\u201329.","journal-title":"Surg Endosc"},{"issue":"Suppl 9","key":"1358_CR4","first-page":"S334","volume":"179","author":"ME Sugrue","year":"2010","unstructured":"Sugrue ME. Fenestrated linea alba a potential trap in umbilical hernia repair- beware! Ir J Med Sci. 2010;179(Suppl 9):S334-373.","journal-title":"Ir J Med Sci"},{"key":"1358_CR5","first-page":"504","volume":"18","author":"AV Moschcowitz","year":"1914","unstructured":"Moschcowitz AV. The pathogenesis and treatment of hernise of the linea alba. Surg Gynec Obst. 1914;18:504\u20137.","journal-title":"Surg Gynec Obst"},{"issue":"5","key":"1358_CR6","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1097\/00000658-191505000-00006","volume":"61","author":"AV Moschcowitz","year":"1915","unstructured":"Moschcowitz AV. The pathogenesis of umbilical hernia. Ann Surg. 1915;61(5):570\u201381.","journal-title":"Ann Surg"},{"key":"1358_CR7","doi-asserted-by":"publisher","first-page":"3161","DOI":"10.1007\/s00464-016-5073-9","volume":"30","author":"BT Heniford","year":"2016","unstructured":"Heniford BT. SAGES guidelines for laparoscopic ventral hernia repair. Surg Endosc. 2016;30:3161\u20132.","journal-title":"Surg Endosc"},{"key":"1358_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.21037\/ales.2018.12.09","volume":"4","author":"M Ra","year":"2019","unstructured":"Ra M. Umbilical hernia: when and how. Ann Laparosc Endosc Surg. 2019;4:1.","journal-title":"Ann Laparosc Endosc Surg"},{"issue":"4","key":"1358_CR9","first-page":"350","volume":"12","author":"L Venclauskas","year":"2017","unstructured":"Venclauskas L, Jokubauskas M, Zilinskas J, Zviniene K, Kiudelis M. Long-term follow-up results of umbilical hernia repair. Wideochir Inne Tech Maloinwazyjne. 2017;12(4):350\u20136.","journal-title":"Wideochir Inne Tech Maloinwazyjne"},{"issue":"7","key":"1358_CR10","doi-asserted-by":"publisher","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","volume":"6","author":"D Moher","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.","journal-title":"PLoS Med"},{"issue":"9","key":"1358_CR11","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","volume":"73","author":"K Slim","year":"2003","unstructured":"Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712\u20136.","journal-title":"ANZ J Surg"},{"issue":"10123","key":"1358_CR12","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1016\/S0140-6736(18)30298-8","volume":"391","author":"R Kaufmann","year":"2018","unstructured":"Kaufmann R, Halm JA, Eker HH, Klitsie PJ, Nieuwenhuizen J, Van Geldere D, Simons MP, Van der Harst E, van\u2019t Riet M, Van der Holt B, et al. Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet. 2018;391(10123):860\u20139.","journal-title":"Lancet"},{"issue":"4","key":"1358_CR13","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1016\/j.amjsurg.2014.05.021","volume":"209","author":"MW Christoffersen","year":"2015","unstructured":"Christoffersen MW, Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P, Bisgaard T. Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study. Am J Surg. 2015;209(4):725\u201332.","journal-title":"Am J Surg"},{"issue":"5","key":"1358_CR14","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1001\/jamasurg.2016.5052","volume":"152","author":"DA Shankar","year":"2017","unstructured":"Shankar DA, Itani KMF, O\u2019Brien WJ, Sanchez VM. Factors associated with long-term outcomes of umbilical hernia repair. JAMA Surg. 2017;152(5):461\u20136.","journal-title":"JAMA Surg"},{"issue":"1","key":"1358_CR15","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1097\/SLA.0000000000003086","volume":"270","author":"JEH Ponten","year":"2019","unstructured":"Ponten JEH, Leclercq WKG, Lettinga T, Heemskerk J, Konsten JLM, Bouvy ND, Nienhuijs SW. Mesh OR patch for hernia on epigastric and umbilical sites (MORPHEUS-Trial): the complete two-year follow-up. Ann Surg. 2019;270(1):33\u20137.","journal-title":"Ann Surg"},{"issue":"4","key":"1358_CR16","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1016\/j.surg.2019.04.040","volume":"166","author":"K Donovan","year":"2019","unstructured":"Donovan K, Denham M, Kuchta K, Denham W, Linn JG, Haggerty SP, Carbray J, Ujiki M. Predictors for recurrence after open umbilical hernia repair in 979 patients. Surgery. 2019;166(4):615\u201322.","journal-title":"Surgery"},{"issue":"4","key":"1358_CR17","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1007\/s10029-016-1466-x","volume":"20","author":"A Winsnes","year":"2016","unstructured":"Winsnes A, Haapam\u00e4ki MM, Gunnarsson U, Strig\u00e5rd K. Surgical outcome of mesh and suture repair in primary umbilical hernia: postoperative complications and recurrence. Hernia. 2016;20(4):509\u201316.","journal-title":"Hernia"},{"issue":"1","key":"1358_CR18","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.amjsurg.2015.03.014","volume":"211","author":"JJ Yao","year":"2016","unstructured":"Yao JJ, Pham T, El Mokdad A, Huerta S. Predictors of recurrence of umbilical hernias following primary tissue repair in obese veterans. Am J Surg. 2016;211(1):18\u201323.","journal-title":"Am J Surg"},{"issue":"5","key":"1358_CR19","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1007\/s10029-018-1791-3","volume":"22","author":"D Cheng","year":"2018","unstructured":"Cheng D, Bonato L, Leinkram C. Infection and recurrence rates of the C-QUR V-patch. Hernia. 2018;22(5):767\u201372.","journal-title":"Hernia"},{"issue":"2","key":"1358_CR20","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1007\/s00464-015-4258-y","volume":"30","author":"D Froylich","year":"2016","unstructured":"Froylich D, Segal M, Weinstein A, Hatib K, Shiloni E, Hazzan D. Laparoscopic versus open ventral hernia repair in obese patients: a long-term follow-up. Surg Endosc. 2016;30(2):670\u20135.","journal-title":"Surg Endosc"},{"issue":"1","key":"1358_CR21","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1007\/s00464-016-4984-9","volume":"31","author":"K Mitura","year":"2017","unstructured":"Mitura K, Skolimowska-Rzewuska M, Garnysz K. Outcomes of bridging versus mesh augmentation in laparoscopic repair of small and medium midline ventral hernias. Surg Endosc. 2017;31(1):382\u20138.","journal-title":"Surg Endosc"},{"issue":"4","key":"1358_CR22","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1016\/j.amjsurg.2007.04.013","volume":"195","author":"AA Saber","year":"2008","unstructured":"Saber AA, Rao AJ, Itawi EA, Elgamal MH, Martinez RL. Occult ventral hernia defects: a common finding during laparoscopic ventral hernia repair. Am J Surg. 2008;195(4):471\u20133.","journal-title":"Am J Surg"},{"issue":"3","key":"1358_CR23","doi-asserted-by":"publisher","first-page":"105","DOI":"10.4103\/ijawhs.ijawhs_27_19","volume":"2","author":"R Bittner","year":"2019","unstructured":"Bittner R. Medico-legal implications in hernia surgery. Int J Abdom Wall Hernia Surg. 2019;2(3):105\u201313.","journal-title":"Int J Abdom Wall Hernia Surg"},{"issue":"2","key":"1358_CR24","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.jamcollsurg.2013.04.020","volume":"217","author":"B Z\u00f6ller","year":"2013","unstructured":"Z\u00f6ller B, Ji J, Sundquist J, Sundquist K. Shared and nonshared familial susceptibility to surgically treated inguinal hernia, femoral hernia, incisional hernia, epigastric hernia, and umbilical hernia. J Am Coll Surg. 2013;217(2):289-299.e281.","journal-title":"J Am Coll Surg"},{"issue":"1","key":"1358_CR25","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/s00268-014-2765-y","volume":"39","author":"G K\u00f6hler","year":"2015","unstructured":"K\u00f6hler G, Luketina RR, Emmanuel K. Sutured repair of primary small umbilical and epigastric hernias: concomitant rectus diastasis is a significant risk factor for recurrence. World J Surg. 2015;39(1):121\u20136.","journal-title":"World J Surg"},{"key":"1358_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fsurg.2019.00001","volume":"6","author":"W Reinpold","year":"2019","unstructured":"Reinpold W, K\u00f6ckerling F, Bittner R, Conze J, Fortelny R, Koch A, Kukleta J, Kuthe A, Lorenz R, Stechemesser B. Classification of Rectus Diastasis-A Proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS). Front Surg. 2019;6:1.","journal-title":"Front Surg"},{"issue":"4","key":"1358_CR27","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1016\/j.surg.2020.01.001","volume":"167","author":"JS Jolissaint","year":"2020","unstructured":"Jolissaint JS, Dieffenbach BV, Tsai TC, Pernar LI, Shoji BT, Ashley SW, Tavakkoli A. Surgical site occurrences, not body mass index, increase the long-term risk of ventral hernia recurrence. Surgery. 2020;167(4):765\u201371.","journal-title":"Surgery"},{"key":"1358_CR28","first-page":"24","volume":"2","author":"F K\u00f6ckerling","year":"2015","unstructured":"K\u00f6ckerling F, Koch A, Lorenz R, Schug-Pass C, Stechemesser B, Reinpold W. How long do we need to follow-up our hernia patients to find the real recurrence rate? Front Surg. 2015;2:24.","journal-title":"Front Surg"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01358-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-021-01358-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01358-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T13:05:42Z","timestamp":1634043942000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsurg.biomedcentral.com\/articles\/10.1186\/s12893-021-01358-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,12]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1358"],"URL":"https:\/\/doi.org\/10.1186\/s12893-021-01358-1","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,12]]},"assertion":[{"value":"4 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"N\/A.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"365"}}