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.

References

  1. "Hernia, Umbilical - PubMed - NCBI".
  2. "Hernia, Pediatric Umbilical - PubMed - NCBI".

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