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:

• 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.
  • After local anesthesia, a small curvilinear incision is made into the skin crease of the umbilicus
  • the sac is dissected free from the overlying skin as well the fascial defect to ensure not abdominal content are present prior repair of the fascial defects.
  • The fascial defect is repaired with absorbable, interrupted sutures that are typically placed in a transverse plane.
  • The skin is closed using subcuticular sutures, either monocryl or vicryl. The postoperative recovery is usually uneventful. Recurrence is uncommon, but often seen in children with elevated intra-abdominal pressures.

• In adults
  • Small defects are closed primarily after separation of the sac from the overlying umbilicus and surrounding fascia.
  • Defects greater than 3 cm are closed using prosthetic mesh.
  • No prospective data have conclusively found clear advantages of one technique over another.

• Options for mesh implantation include bridging the defect and placing a preperitoneal underlay of mesh reinforced with suture repair.
• The laparoscopic technique requires general anesthesia and is reserved for large defects or recurrent umbilical hernias.