Umbilical hernia is common in children. As these congenital hernias usually close spontaneously, they should not be repaired before 5 years of age. Surgical repair of umbilical and para-umbilical hernia is necessary in adults, as strangulation is always a possibility.

Technique

1	Make a transverse incision just below the umbilicus (Figure 8.30).
Figure 8.30
2	Clearly define the neck of the sac as it emerges through the linea alba and make an opening in the neck (Figures 8.31 and 8.32). Check for adhesions between the herniated mass and the inside of the sac, using a finger. Complete the division of the neck of the sac while protecting its contents. Carefully examine the contents of the sac (the gut and omentum) and reduce them (Figures 8.33 and 8.34). If the herniated mass consists of omentum alone, divide it in small segments between artery forceps and transfix the remaining tissue. Excise the sac (with any attached omentum) from under the umbilical skin.
Figure 8.31
Figure 8.32
Figure 8.33
Figure 8.34
3	Using blunt dissection, clearly define the fibrous margins of the defect and enlarge it laterally (Figure 8.35). Make the repair by inserting mattress stitches of 0 non-absorbable suture through all layers of the wound so that the edges overlap; the peritoneum need not be closed separately (Figure 8.36). Apply a further row of stitches to approximate the overlapping edge to the linea alba (Figure 8.37). Complete closure by stitching the skin with 2/0 suture. Then apply a single-layer gauze dressing.
Figure 8.35
Figure 8.36
Figure 8.37

Use the same procedure in children, again making a curved incision below the umbilicus. Use simple, interrupted sutures to close small defects.