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><ref name="BlayStulberg2017">{{cite journal|last1=Blay|first1=Eddie|last2=Stulberg|first2=Jonah J.|title=Umbilical Hernia|journal=JAMA|volume=317|issue=21|year=2017|pages=2248|issn=0098-7484|doi=10.1001/jama.2017.3982}}</ref><ref name="Kim2017">{{cite journal|last1=Kim|first1=Lawrence T.|title=Complexity of the “Simple” Umbilical Hernia Repair|journal=JAMA Surgery|volume=152|issue=5|year=2017|pages=466|issn=2168-6254|doi=10.1001/jamasurg.2016.5053}}</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== | ||
*Surgical repair for an uncomplicated umbilical hernia is done under general anesthesia as an outpatient procedure. | [[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><ref name="pmid28065949">{{cite journal| author=Tunio NA| title=Hernioplasty: Tension free mesh repair versus Mayos repair for umbilical hernias. | journal=J Pak Med Assoc | year= 2017 | volume= 67 | issue= 1 | pages= 24-26 | pmid=28065949 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28065949 }} </ref><ref name="ShankarItani2017">{{cite journal|last1=Shankar|first1=Divya A.|last2=Itani|first2=Kamal M. F.|last3=O’Brien|first3=William J.|last4=Sanchez|first4=Vivian M.|title=Factors Associated With Long-term Outcomes of Umbilical Hernia Repair|journal=JAMA Surgery|volume=152|issue=5|year=2017|pages=461|issn=2168-6254|doi=10.1001/jamasurg.2016.5052}}</ref> | ||
**Small curvilinear incision is made into the skin crease of the umbilicus | |||
**Sac is dissected free from the overlying skin and the fascial defect | *Surgical repair for an uncomplicated umbilical hernia is done under [[General anaesthesia|general anesthesia]] as an outpatient procedure. | ||
***Ensures that no abdominal content are present prior to the repair | **Small curvilinear incision is made into the [[skin]] crease of the [[Navel|umbilicus]] | ||
**Fascial defect is repaired with absorbable, interrupted sutures | **Sac is dissected free from the overlying [[skin]] and the [[Fascial compartment|fascial]] defect | ||
**Skin is closed using subcuticular sutures with monocryl or vicryl | ***Ensures that no [[Abdomen|abdominal]] content are present prior to the repair | ||
**[[Fascial compartment|Fascial]] defect is repaired with absorbable, interrupted [[Suture|sutures]] | |||
**[[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. | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastroenterology]] | |||
[[Category:Surgery]] | |||
[[Category:Pediatrics]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
{{WS}} | {{WS}} | ||
{{WH}} | {{WH}} | ||
Latest revision as of 20:20, 11 January 2019
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Umbilical hernia Microchapters |
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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][3][4]
- 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][5][6][7]
- 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.
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References
- ↑ 1.0 1.1 "Hernia, Umbilical - PubMed - NCBI".
- ↑ 2.0 2.1 "Hernia, Pediatric Umbilical - PubMed - NCBI".
- ↑ Blay, Eddie; Stulberg, Jonah J. (2017). "Umbilical Hernia". JAMA. 317 (21): 2248. doi:10.1001/jama.2017.3982. ISSN 0098-7484.
- ↑ Kim, Lawrence T. (2017). "Complexity of the "Simple" Umbilical Hernia Repair". JAMA Surgery. 152 (5): 466. doi:10.1001/jamasurg.2016.5053. ISSN 2168-6254.
- ↑ 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.
- ↑ Tunio NA (2017). "Hernioplasty: Tension free mesh repair versus Mayos repair for umbilical hernias". J Pak Med Assoc. 67 (1): 24–26. PMID 28065949.
- ↑ Shankar, Divya A.; Itani, Kamal M. F.; O’Brien, William J.; Sanchez, Vivian M. (2017). "Factors Associated With Long-term Outcomes of Umbilical Hernia Repair". JAMA Surgery. 152 (5): 461. doi:10.1001/jamasurg.2016.5052. ISSN 2168-6254.