Preprocedural Evaluation

Umbilical hernias are typically diagnosed with a detailed history and physical examination. Patients generally complain of pain or a lump at the umbilicus. On physical examination, a protrusion at the umbilicus can be seen. Paraumbilical hernias are more common in women than in men. Findings are confirmed by palpating a fascial defect or by visualizing the hernia with increasing intra-abdominal pressure by straining. The fascial defect is usually smaller than the sac.

Computed tomography (CT) is not required but can be used to diagnose defects that are difficult to appreciate on physical examination.

Equipment

A general surgery tray with basic surgical instruments should be used. The type of mesh used is typically based on the individual surgeon's preference, but polypropylene or polytetrafluoroethylene (PTFE) mesh is a common choice.

Anesthesia

General endotracheal anesthesia or intravenous sedation with local anesthesia^[14]can be used for open repair.

Positioning

The patient should be placed in the supine position with arms out at 90°.

Monitoring & Follow-up

Patients should be instructed to avoid heavy lifting for 2-4 weeks postoperatively. Obese patients should be counseled on strategies for weight management. Continued medical control helps to decrease the risk of recurrence in patients with ascites.

Technique

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