Notes on Umbilical Hernia Operation

Umbilical Hernia

Relative Indications:

• Discomfort
• Irreducible; because of long standing and loculations

Absolute Indications:

• Obstruction
• Strangulation
• Ulcerated skin

Contraindications:

• Obesity
• Chronic cardiovascular or respiratory illness
• Ascites

Operation:

Incision is two semilunars on opposite sides joined at extremity, with little skin involvement, as more skin can always be cut later on. Umbilicus is excised as well as redundant skin and fat upto muscular aponeurosis. Identify neck of sac, margins of aponeurosis about the neck are dissected. Dissect skin and fat off the sac, open it and if adhesions and loculations are present either insert a finger and proceed with the help of finger or if no loculations are present than do adhesionlysis from the lining of sac, divide and ligate if requires, omentum if doubtful viable; is excised, contents freed and reduced. Enlarge the defect laterally for 3-4 cm and grasp aponeurosis, posterior rectus sheath and peritoneum in a haemostat and suture as illustrated:





Mayo Repair:

Principles:

• Upper flap distance is 2-4 cm from edge while lower flaps are greater than 1 cm
• All the stitches are staggered i.e., placed at different lengths from edges so that the tension is evenly distributed. 
• Suture with triple layer and double throw knots. 
• Place a suction drain b/w two flaps and edge of upper flap is sutures to anterior surface of lower flap with 1cm bites at each end, close with another suction drain and avoid skin stitches if possible.