Umbilical hernia surgery: Difference between revisions

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==Overview==
==Overview==
Umbilical hernia surgery is indicated when umbilical hernia is larger than 2cm, “elephant’s trunk” appearance, does not spontaneously close by 5 to 6 years of age, symptomatic, strangulation, or increases in size after the age of 1 to 2 years. Surgical repair for an uncomplicated umbilical hernia is done under general anesthesia as an outpatient procedure. Mesh implantation include bridging the defect and placing a preperitoneal mesh with suture repair. Postoperative recovery is usually uneventful. Recurrence is seen in patients with elevated intra-abdominal pressures. Laparoscopic technique is reserved for large defects or recurrent umbilical hernias.
Umbilical hernia [[surgery]] is indicated when umbilical hernia is larger than 2cm, “elephant’s trunk” appearance, does not spontaneously close by 5 to 6 years of age, symptomatic, strangulation, or increases in size after the age of 1 to 2 years. [[Surgery|Surgical]] repair for an uncomplicated umbilical hernia is done under [[General anaesthesia|general anesthesia]] as an outpatient procedure. [[Mesh]] implantation include bridging the defect and placing a preperitoneal [[mesh]] with [[suture]] repair. Postoperative recovery is usually uneventful. Recurrence is seen in patients with elevated intra-[[Abdomen|abdominal]] pressures. [[Laparoscopic surgery|Laparoscopic]] technique is reserved for large defects or recurrent umbilical hernias.
==Indications==
==Indications==
*Umbilical hernia surgery is indicated in the following cases:<ref name="urlHernia, Umbilical - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/29083594 |title=Hernia, Umbilical - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlHernia, Pediatric Umbilical - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/29083740 |title=Hernia, Pediatric Umbilical - PubMed - NCBI |format= |work= |accessdate=}}</ref>
*Umbilical hernia [[surgery]] is indicated in the following cases:<ref name="urlHernia, Umbilical - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/29083594 |title=Hernia, Umbilical - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlHernia, Pediatric Umbilical - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/29083740 |title=Hernia, Pediatric Umbilical - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="BlayStulberg2017">{{cite journal|last1=Blay|first1=Eddie|last2=Stulberg|first2=Jonah J.|title=Umbilical Hernia|journal=JAMA|volume=317|issue=21|year=2017|pages=2248|issn=0098-7484|doi=10.1001/jama.2017.3982}}</ref><ref name="Kim2017">{{cite journal|last1=Kim|first1=Lawrence T.|title=Complexity of the “Simple” Umbilical Hernia Repair|journal=JAMA Surgery|volume=152|issue=5|year=2017|pages=466|issn=2168-6254|doi=10.1001/jamasurg.2016.5053}}</ref>
**Larger than 2 cm
**Larger than 2 cm
**“Elephant’s trunk” appearance
**“Elephant’s trunk” appearance
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**Symptomatic
**Symptomatic
**Strangulation  
**Strangulation  
**Hernia increases in size after the age of 1 to 2 years
**[[Hernia]] increases in size after the age of 1 to 2 years


==Surgery==
==Surgery==
*Surgical repair for an uncomplicated umbilical hernia is done under general anesthesia as an outpatient procedure.  
[[Surgery]] for umbilical hernia is as follows:<ref name="urlHernia, Umbilical - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/29083594 |title=Hernia, Umbilical - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlHernia, Pediatric Umbilical - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/29083740 |title=Hernia, Pediatric Umbilical - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="KellyPonsky2013">{{cite journal|last1=Kelly|first1=Katherine B.|last2=Ponsky|first2=Todd A.|title=Pediatric Abdominal Wall Defects|journal=Surgical Clinics of North America|volume=93|issue=5|year=2013|pages=1255–1267|issn=00396109|doi=10.1016/j.suc.2013.06.016}}</ref><ref name="pmid28065949">{{cite journal| author=Tunio NA| title=Hernioplasty: Tension free mesh repair versus Mayos repair for umbilical hernias. | journal=J Pak Med Assoc | year= 2017 | volume= 67 | issue= 1 | pages= 24-26 | pmid=28065949 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28065949  }} </ref><ref name="ShankarItani2017">{{cite journal|last1=Shankar|first1=Divya A.|last2=Itani|first2=Kamal M. F.|last3=O’Brien|first3=William J.|last4=Sanchez|first4=Vivian M.|title=Factors Associated With Long-term Outcomes of Umbilical Hernia Repair|journal=JAMA Surgery|volume=152|issue=5|year=2017|pages=461|issn=2168-6254|doi=10.1001/jamasurg.2016.5052}}</ref>
**Small curvilinear incision is made into the skin crease of the umbilicus
**Sac is dissected free from the overlying skin and the fascial defect
***Ensures that no abdominal content are present prior to the repair  
**Fascial defect is repaired with absorbable, interrupted sutures
**Skin is closed using subcuticular sutures with monocryl or vicryl
*Postoperative recovery is usually uneventful.  
*Recurrence is seen in patients with elevated intra-abdominal pressures.


*Surgical repair for an uncomplicated umbilical hernia is done under [[General anaesthesia|general anesthesia]] as an outpatient procedure.
**Small curvilinear incision is made into the [[skin]] crease of the [[Navel|umbilicus]]
**Sac is dissected free from the overlying [[skin]] and the [[Fascial compartment|fascial]] defect
***Ensures that no [[Abdomen|abdominal]] content are present prior to the repair
**[[Fascial compartment|Fascial]] defect is repaired with absorbable, interrupted [[Suture|sutures]]
**[[Skin]] is closed using subcuticular [[Suture|sutures]] with [[monocryl]] or [[vicryl]]
*In adults
*In adults
**Small defects are closed after separation of the sac from the overlying umbilicus and surrounding fascia.  
**Small defects are closed after separation of the sac from the overlying [[Navel|umbilicus]] and surrounding [[fascia]].  
**Defects greater than 3 cm are closed using prosthetic mesh.  
**Defects greater than 3 cm are closed using prosthetic [[mesh]].  
**No data shows clear advantages of one technique over another.
**No data shows clear advantages of one technique over another.


*Mesh implantation include bridging the defect and placing a preperitoneal mesh with suture repair.  
*[[Mesh]] implantation include bridging the defect and placing a preperitoneal [[mesh]] with [[suture]] repair.  
*Laparoscopy is reserved for large defects or recurrent umbilical hernias.
*[[Laparoscopic surgery|Laparoscopy]] is reserved for large defects or recurrent umbilical hernias.
*Postoperative recovery is usually uneventful.
*Recurrence is seen in patients with elevated intra-[[Abdomen|abdominal]] pressures.
 
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==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Pediatrics]]
[[Category:Up-To-Date]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Gastroenterology]]


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Latest revision as of 20:20, 11 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

Umbilical hernia surgery is indicated when umbilical hernia is larger than 2cm, “elephant’s trunk” appearance, does not spontaneously close by 5 to 6 years of age, symptomatic, strangulation, or increases in size after the age of 1 to 2 years. Surgical repair for an uncomplicated umbilical hernia is done under general anesthesia as an outpatient procedure. Mesh implantation include bridging the defect and placing a preperitoneal mesh with suture repair. Postoperative recovery is usually uneventful. Recurrence is seen in patients with elevated intra-abdominal pressures. Laparoscopic technique is reserved for large defects or recurrent umbilical hernias.

Indications

  • Umbilical hernia surgery is indicated in the following cases:[1][2][3][4]
    • Larger than 2 cm
    • “Elephant’s trunk” appearance
    • Did not spontaneously close by 5 to 6 years of age
    • Symptomatic
    • Strangulation
    • Hernia increases in size after the age of 1 to 2 years

Surgery

Surgery for umbilical hernia is as follows:[1][2][5][6][7]

  • Surgical repair for an uncomplicated umbilical hernia is done under general anesthesia as an outpatient procedure.
  • In adults
    • Small defects are closed after separation of the sac from the overlying umbilicus and surrounding fascia.
    • Defects greater than 3 cm are closed using prosthetic mesh.
    • No data shows clear advantages of one technique over another.
  • Mesh implantation include bridging the defect and placing a preperitoneal mesh with suture repair.
  • Laparoscopy is reserved for large defects or recurrent umbilical hernias.
  • Postoperative recovery is usually uneventful.
  • Recurrence is seen in patients with elevated intra-abdominal pressures.

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References

  1. 1.0 1.1 "Hernia, Umbilical - PubMed - NCBI".
  2. 2.0 2.1 "Hernia, Pediatric Umbilical - PubMed - NCBI".
  3. Blay, Eddie; Stulberg, Jonah J. (2017). "Umbilical Hernia". JAMA. 317 (21): 2248. doi:10.1001/jama.2017.3982. ISSN 0098-7484.
  4. Kim, Lawrence T. (2017). "Complexity of the "Simple" Umbilical Hernia Repair". JAMA Surgery. 152 (5): 466. doi:10.1001/jamasurg.2016.5053. ISSN 2168-6254.
  5. Kelly, Katherine B.; Ponsky, Todd A. (2013). "Pediatric Abdominal Wall Defects". Surgical Clinics of North America. 93 (5): 1255–1267. doi:10.1016/j.suc.2013.06.016. ISSN 0039-6109.
  6. Tunio NA (2017). "Hernioplasty: Tension free mesh repair versus Mayos repair for umbilical hernias". J Pak Med Assoc. 67 (1): 24–26. PMID 28065949.
  7. Shankar, Divya A.; Itani, Kamal M. F.; O’Brien, William J.; Sanchez, Vivian M. (2017). "Factors Associated With Long-term Outcomes of Umbilical Hernia Repair". JAMA Surgery. 152 (5): 461. doi:10.1001/jamasurg.2016.5052. ISSN 2168-6254.

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