Sutured Repair of Primary Small Umbilical and Epigastric Hernias: Concomitant Rectus Diastasis Is a Significant Risk Factor for Recurrence

We strongly recommend preoperatively checking for rectus diastasis and using nonabsorbable sutures as an alternative to mesh repair only when repairing small umbilical or epigastric hernias (<2 cm) and there is no concomitant rectus diastasis. Patients with coexistent rectus diastasis definitely benefit from mesh-based repair of the midline to decrease the recurrence rate.