Umbilical hernia surgery
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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.
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
- 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
- Postoperative recovery is usually uneventful.
- Recurrence is seen in patients with elevated intra-abdominal pressures.
- 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.
- Laparoscopic technique requires general anesthesia and is reserved for large defects or recurrent umbilical hernias.