Umbilical hernias are commonly diagnosed ventral abdominal wall defects and are frequently managed electively. Diagnosis is primarily clinical but may be supported by imaging modalities such as computed tomography (CT), ultrasound (US), or magnetic resonance imaging (MRI). Although most patients remain asymptomatic, surgical intervention is required for definitive repair. However, delayed repair can transform a low-risk outpatient procedure into a surgical emergency associated with increased morbidity and limited operative options, including the inability to place mesh. The absence of mesh reinforcement is associated with substantially higher recurrence rates, even in small hernias. Therefore, patient education and elective surgical repair of umbilical hernias should occur before complications arise that restrict mesh use. We present the case of a 64-year-old man with a previously diagnosed umbilical hernia who deferred elective repair and subsequently presented with acute abdominal pain due to incarceration. Emergent robotic-assisted repair was performed, requiring extensive lysis of adhesions and primary fascial closure with suture. Intraoperative findings of bowel edema and serosanguineous fluid rendered the surgical field contaminated, ultimately precluding mesh placement. This case highlights the tangible cost of delayed elective umbilical hernia repair. Deferral of intervention can lead to emergent presentation, limit surgical options, and increase the risk of recurrence. The true cost of delay is not the emergent operation itself, but the permanent loss of the ability to perform the most durable repair possible.
Castillo et al. (Thu,) studied this question.