UMBILICA

L HERNIA
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Definition
 Definition
Umbilicus
Represent midline opening in
the linea alba

Umbilical Hernia
• when the umbilical scar closes
incompletely in the child or fails and
stretches in later years in the adult
patien

• the abdominal contents move through

the umbilical opening given the relative
lack of soft tissue in the anterior body
wall at the site of the umbilicus
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Insidence
 In Caucasian babies, the incidence has been
In child reported at 10–30%, more common in premature
infants, a tendency for familial inheritance

The majority known to close over time, as the infant

becomes a child, by school age, 10% of umbilical
In adult
hernias remain open on physical examination.

rarely performed electively before the age of 2 years,

and incarceration in the child is rare.

pediatric surgical literature advise the delay of

umbilical hernia repair until at least 2–3 years of age
In adult

Female: male = 3: 1

association with processes that

increase intra-abdominal pressure

such as pregnancy, obesity, ascites,

persistent or repetitive abdominal
distention in bowel obstruction, or
peritoneal dialysis.
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Embryology and
Anatomy
 3rd week gestation 5th week gestation 6th week gestation
The fascial margins that Umbilical cord takes shape intestinal tract migrates through the
make up the umbilical umbilicus and outside the coelom as
defect are formed intestinal growth outpaces the size of
the abdominal cavity

1 22 3
 At birth
when the umbilical cord is manually
10 week gestation
th ligated, the umbilical arteries and vein
thrombose and the umbilical aperture
the four folds of the
intestinal tract returns to close. Any defect in the process of
somatopleure begin to fuse
the abdominal cavity umbilical closure will result in an
inward. This, in turn, forms
through the umbilical defect umbilical hernia through which omentum
the tight umbilical defect,
as the midgut undergoes or bowel can herniate.
which allows only the
rotation
passage of the umbilical
vessels.

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Clinical
Manifestation

● History: vague abdominal pain
associated with herniation and
reduction
● Inspection: soft bulge located
anterior or adjacent to the umbilicus
● Palpation: bulge will be readily
reducible so that the actual fascial
defect can be easily defined
In adult
● Symptomatic and does not show a tendency to
close without intervention
● Hernia contents increase in size, the overlying
umbilical skin may become thin and ultimately
ulcerated by pressure necrosis
● Examintation: Incarcerated hernia  significant
tenderness
● The small, asymptomatic, reducible hernia in the
adult can be observed without the need for
immediate intervention
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Treatment
 In child

Dissection is carried
through the
a short curvilinear A skin flap is then
subcutaneous
(smile) incision is raised cephalad
tissues and down to
made just inferior to using blunt
the fascial level.
the umbilicus in the dissection and low-
The neck of the sac
typical skin crease. level electrocautery.
is then encircled
with a hemostat
 In child

After the sac is

dissected free of its
umbilical
attachments, it can The redundant This operation is
be reduced or portion of the sac can usually performed
inverted completely be excised using under general
into the peritoneal electrocautery anesthe
cavity or incised to
explore the contents
of the hernia sac.
 In Adult
● Local anesthesia with the possible addition of intravenous sedation
● Curvilinear incision, placed transversely on the inferior border of the
umbilicus or vertically on one curved edge of the umbilicus (Fig. 7-8)
● A skin flap is raised to elevate the umbilicus off the hernia sac. The sac
is again dissected free of its fascial attachments to isolate the sac for
complete reduction and to allow for an adequate width of fascia for
suture closure
● The sac contents are then reduced into the abdominal cavity and any
excess sac can be excised.
● The defect is then closed with a strong, nonabsorbable suture (such as
0 polypropylene or nylon), usually in an interrupted fashion
● The fascial edges are approximated through this technique. The
traditional “vest-over-pants” technique originated by Mayo is less
commonly utilized since overlapping fascial closures have been shown
to weaken the overall wound strength in hernia repair
 In Adult
● In large defects that may close only with a significant degree of
tension, a cone of polypropylene mesh can be fitted to fill the umbilical
defect in place of a tissue repair
● The mesh is then sutured circumferentially to the surrounding
umbilical fascia to prevent migration
● Newer mesh products contain polypropylene mesh or polyester mesh
in combination with a bioabsorbable layer so that they can be placed in
contact with the bowel without the formation of significant adhesions.
● These products can be very useful in the treatment of umbilical and
other ventral hernias where mesh adherence to bowel is a concern.
(E). The dermis/cicatrix below the
umbilicus is sutured to fascia for
cosmetic restoration using
absorbable suture

(F). Skin is closed with subcuticular

suture

(G), a liquid adhesive and steri-

strips are applied, and the wound is
dressed with a pressure bandage.
THANKYO
U