Umbilical hernia

An umbilical hernia can give complaints of pain or can be cosmetically annoying. The content of the hernia mostly consists of fat.

12 3 4 5

At the operation an incision at the lower part of the umbilicus is made (2) and the hernia is freed from the skin and surrounding tissues and fascia (3,4,5)

6 7 8

The hernial sac is opened and controlled for its content (6). If there is only fatty tissue, like in this case, then it can be removed (7). Shoud the content be part of the bowel (8), then ofcourse this should be freed and put back in the abdominal cavity.

9 10

If there is only a small hole in the fascia, it can easily be closed with sutures. In this case the defect measures over 2cm and in these cases it is wiser to add prosthetic material. A polypropyleen gauze (9) is positioned superficial of the closed peritoneum, deep to the fascia (10). 

11 12 13 14

The fascia is then closed over the polypropyleen in a rooftilemanner with sutures (11). If the defect is too large, the suturing is not done. Then the umbilicus is sutured to the deep layers (12) and the skin is closed subcutaneously (13,14).  Showering is permitted the day after the operation. 

A recent innovation of the above mentioned polypropyleen enables the use of the prosthesis in the abdomen without the need to close the peritoneum, which is sometimes bothersome. It simplifies the operation and lessens the chance of adhesionformation of bowel to the prosthesis. The prosthesis consists of two parts, one polypropyleen that gives good ingrowth in tissue and one ePTFE (better known as goretex) that does not adhere to tissue. 

15 16 17 18 19

As in the example above the incision and freeing of the hernia takes place. The defect is shown. Room is made for the prosthesis (15-19).

20 21 22 23 24

The prosthesis is far larger than the defect and is folded to facilitate insertion. Because a memory recoil is present in the prosthesis it unfolds again. The position is checked and the the laces of the prosthesis are being cut and sewn to the fascial rim. Because the defect is not closed there will be no tension in the wound leading to lesser pain afterwards and no hazard of tearing of the sutures (20-27).

25 26 27 28 29

The skin is sutured subcutaneously. Showering is permitted (28,29). look at the video for intra abdominal position.

back / entree