Hernia

Umbilical Hernia Repair (Open)

OPERATION: Umbilical / Para-umbilical Hernia Repair (Open)
ANAESTHETIC: General / local anaesthesia
POSITION: Supine.

INDICATION:
[Symptomatic para-umbilical hernia / umbilical hernia / strangulated umbilical hernia]. [Primary / recurrent]. [Small primary defect <2 cm — primary repair / larger defect — mesh repair planned].

PROCEDURE:
WHO Checklist performed. Abdomen prepared and draped.

ACCESS:
Curved incision in the skin crease above or below the hernia. Extended transversely 2-4 cm each side if required. [Spindle-shaped incision excising the stretched umbilical skin if large hernia.] Aponeurosis exposed for 2 cm around the hernia margin. [Small hernias: umbilical skin preserved by dissecting it off the sac as a flap.]

HERNIAL SAC:
Thinned aponeurotic edge incised circumferentially to expose the peritoneum and the full neck of the sac. Sac entered. Contents assessed — free or adherent omentum [/ bowel]. Contents reduced; adherent fibrous omentum excised if required with ligation of bleeding omental vessels, protecting the transverse colon. Peritoneum separated from the under-surface of the rectus sheath all around. Peritoneal neck closed with continuous 2/0 absorbable suture — transverse linear suture line.

REPAIR: