Umbilical hernia, primary suture repair - general and visceral surgery

Semicircular infraumbilical skin incision (Spitzy skin incision, “smiling incision”)

Transect the subcutis, free the hernia sac from the umbilicus and dissect the sac down to the fascial orifice. Most of the tissue prolapsing through the fascial orifice is preperitoneal epigastric fat.

Free the entire margin of the fascia over a width of about 1cm.

Invaginate the hernia sac with its attached preperitoneal fat and close the fascial orifice in transverse fashion with interrupted sutures (nonabsorbable suture 0/0 to 0/2).

Refixate the umbilicus to the fascia.

Close the subcutis with interrupted sutures. Close the skin with subcuticular sutures. Adapt the wound with Steri-Strips. Dress and model the umbilical contour with a small swab. Adhesive dressing.