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> | ||
**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== | ||
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> | [[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> | ||
*Surgical repair for an uncomplicated umbilical hernia is done under general anesthesia as an outpatient procedure. | *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 umbilicus | **Small curvilinear incision is made into the [[skin]] crease of the [[Navel|umbilicus]] | ||
**Sac is dissected free from the overlying skin and the fascial defect | **Sac is dissected free from the overlying [[skin]] and the [[Fascial compartment|fascial]] defect | ||
***Ensures that no abdominal content are present prior to the repair | ***Ensures that no [[Abdomen|abdominal]] content are present prior to the repair | ||
**Fascial defect is repaired with absorbable, interrupted sutures | **[[Fascial compartment|Fascial]] defect is repaired with absorbable, interrupted [[Suture|sutures]] | ||
**Skin is closed using subcuticular sutures with monocryl or vicryl | **[[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. | *Postoperative recovery is usually uneventful. | ||
*Recurrence is seen in patients with elevated intra-abdominal pressures. | *Recurrence is seen in patients with elevated intra-[[Abdomen|abdominal]] pressures. | ||
==References== | ==References== | ||
Revision as of 02:15, 27 January 2018
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Umbilical hernia surgery On the Web |
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Risk calculators and risk factors for Umbilical hernia surgery |
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]
- 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][3]
- Surgical repair for an uncomplicated umbilical hernia is done under general anesthesia as an outpatient procedure.
- 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
- In adults
- 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.
References
- ↑ 1.0 1.1 "Hernia, Umbilical - PubMed - NCBI".
- ↑ 2.0 2.1 "Hernia, Pediatric Umbilical - PubMed - NCBI".
- ↑ 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.