Umbilical Hernia

umbilical herniaUmbilical hernias are defects of the abdominal wall either through or adjacent to the belly button. Umbilical hernias are very common. Some individuals are born with an umbilical hernia and these may close over time in the early years of life. Many persist and never cause problems to the individual. In some cases, weight gain, pregnancy or a chronic cough can lead to the development of an umbilical hernia in someone who is already predisposed.

Like all hernias, umbilical hernias can enlarge over time. Patients tend to experience more symptoms or cosmetic concerns as the hernia enlarges. As with all hernias there is a potential risk of soft tissue or an organ becoming “stuck” or incarcerated. In some cases, this can require emergency surgery to avoid complications.

How is an Umbilical Hernia Fixed?

The type of repair for an umbilical hernia is related to the size of the abdominal wall defect. The larger the defect the more likely it is to recur after repair with only sutures. A repair that uses only sutures to close an opening in the abdominal wall is referred to as a “primary repair”. The surgical literature has demonstrated a higher likelihood of hernia recurrence when umbilical hernias more than 2 cm (0.75 inches) are repaired primarily. Therefore, most surgeons utilize mesh when performing an umbilical hernia repair for a defect larger than 2 cm.

Can an umbilical hernia be repaired with laparoscopic surgery?

Umbilical hernias can be repaired laparoscopic fashion and it is the method that I prefer. The most common reason for a recurrence is failure to provide enough coverage of the defect with mesh. Using laparoscopic technique, mesh is placed underneath the defect, in surgery this is referred to as an “underlay”. Laparoscopic repair allows for excellent vision of the defect and provides a method for securing an appropriate sized mesh around the defect and in a secure manner.

A recently described technique to address ventral hernias (umbilical, epigastric, Spigelian and incisional) is called eTEP (expanded totally extra-peritoneal) and this can be performed both robotically as well as laparoscopic. The eTEP takes advantage of the layered architecture of the abdominal wall. The mesh is placed in between layers of the abdominal wall, thereby, acting as an underlay patch and in direct contact with musculature. The abdominal cavity is not entered and therefore there is no contact between the mesh and the underlying abdominal organs. At the same time, the mesh is in an ideal location for full tissue integration and incorporation. This diminishes the potential for infections, chronic pain and likely recurrence.

Dr Laker has performed many eTEPs both robotically and laparoscopically to correct hernias of the abdominal wall.

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